{"id":3390,"date":"2022-06-15T14:57:28","date_gmt":"2022-06-15T14:57:28","guid":{"rendered":"https:\/\/713websites.com\/?page_id=3390"},"modified":"2022-06-15T14:57:32","modified_gmt":"2022-06-15T14:57:32","slug":"medical-boarding-agreement","status":"publish","type":"page","link":"https:\/\/713websites.com\/medical-boarding-agreement\/","title":{"rendered":"MEDICAL BOARDING AGREEMENT"},"content":{"rendered":"<script type=\"text\/javascript\">var 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data-formid='8' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_8_3\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_3\" ><label class='gfield_label gform-field-label' for='input_8_3'>Client&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_8_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_2\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_2\" ><label class='gfield_label gform-field-label' for='input_8_2'>Pet&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_8_2' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_4\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_4\" ><label class='gfield_label gform-field-label' for='input_8_4'>Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_4' id='input_8_4' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_8_4_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_8_4_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_8_4' class='gform_hidden' value='https:\/\/713websites.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_8_5\" class=\"gfield gfield--type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_5\" ><label class='gfield_label gform-field-label' for='input_8_5'>Client&#039;s Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_8_5' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_6\" class=\"gfield gfield--type-phone gfield--width-third field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_6\" ><label class='gfield_label gform-field-label' for='input_8_6'>2nd Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_8_6' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_7\" ><legend class='gfield_label gform-field-label' >Does your pet dig?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_7'>\n\t\t\t<div class='gchoice gchoice_8_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Yes'  id='choice_8_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_7_0' id='label_8_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='No'  id='choice_8_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_7_1' id='label_8_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_8\" ><legend class='gfield_label gform-field-label' >Has your pet ever bitten another animal?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_8'>\n\t\t\t<div class='gchoice gchoice_8_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Yes'  id='choice_8_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_8_0' id='label_8_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='No'  id='choice_8_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_8_1' id='label_8_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_9\" ><legend class='gfield_label gform-field-label' >Is your pet territorial about kennel space?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_9'>\n\t\t\t<div class='gchoice gchoice_8_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Yes'  id='choice_8_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_9_0' id='label_8_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No'  id='choice_8_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_9_1' id='label_8_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_12\" ><legend class='gfield_label gform-field-label' >Is your pet friendly towards other pets?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_12'>\n\t\t\t<div class='gchoice gchoice_8_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Yes'  id='choice_8_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_12_0' id='label_8_12_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='No'  id='choice_8_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_12_1' id='label_8_12_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_11\" ><legend class='gfield_label gform-field-label' >Is your pet frightened by thunderstorms?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_11'>\n\t\t\t<div class='gchoice gchoice_8_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Yes'  id='choice_8_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_11_0' id='label_8_11_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='No'  id='choice_8_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_11_1' id='label_8_11_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_10\" ><legend class='gfield_label gform-field-label' >Has your pet ever bitten another person?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_10'>\n\t\t\t<div class='gchoice gchoice_8_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Yes'  id='choice_8_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_10_0' id='label_8_10_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No'  id='choice_8_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_10_1' id='label_8_10_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_13\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_13\" ><label class='gfield_label gform-field-label' for='input_8_13'>If yes, please give brief explanation:<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_8_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_14\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_14\" ><label class='gfield_label gform-field-label' for='input_8_14'>Does your pet have any exercise limits? If so, please explain:<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_8_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_8_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_15\" ><legend class='gfield_label gform-field-label' >Does your pet have any sensitive areas that should not be touched?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_15'>\n\t\t\t<div class='gchoice gchoice_8_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Yes'  id='choice_8_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_15_0' id='label_8_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='No'  id='choice_8_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_15_1' id='label_8_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_16\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_16\" ><label class='gfield_label gform-field-label' for='input_8_16'>If yes, please give brief explanation:<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_8_16' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_8_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_8_17\" ><legend class='gfield_label gform-field-label' >Do we have permission to give your pet Trazadone in the event of excessive anxiety?<\/legend><div class='gfield_description' id='gfield_description_8_17'>($18 FLAT FEE)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_17'>\n\t\t\t<div class='gchoice gchoice_8_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Yes'  id='choice_8_17_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_8_17\"   \/>\n\t\t\t\t\t<label for='choice_8_17_0' id='label_8_17_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='No'  id='choice_8_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_17_1' id='label_8_17_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_18\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_18\" ><label class='gfield_label gform-field-label' for='input_8_18'>Is your pet territorial about toys, food, etc.? If YES, please explain:<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_8_18' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_8_19\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_19\" ><legend class='gfield_label gform-field-label' >Does your pet have any food allergies or sensitivities?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_19'>\n\t\t\t<div class='gchoice gchoice_8_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_8_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_19_0' id='label_8_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_8_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_19_1' id='label_8_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_20\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_20\" ><label class='gfield_label gform-field-label' for='input_8_20'>If yes, please explain:<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_8_20' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_8_21\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_21\" ><legend class='gfield_label gform-field-label' >Does your pet have history of seizures?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_21'>\n\t\t\t<div class='gchoice gchoice_8_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Yes'  id='choice_8_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_21_0' id='label_8_21_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='No'  id='choice_8_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_21_1' id='label_8_21_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_22\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_22\" ><label class='gfield_label gform-field-label' for='input_8_22'>If YES, please explain:<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_8_22' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_23\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_23\" ><label class='gfield_label gform-field-label' for='input_8_23'>Please list all medical conditions and\/or previous illness<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_23' id='input_8_23' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_24\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_24\" ><label class='gfield_label gform-field-label' for='input_8_24'>Please list any medication that your pet will need while boarding with us. Please describe the dose you administer to your pet, how often it is given and when the next dose is needed.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_8_24' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_8_25\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_25\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Additional services: (Check any that apply)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_25'><div class='gchoice gchoice_8_25_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.1' type='checkbox'  value='Wellness Exam ($46)'  id='choice_8_25_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_1' id='label_8_25_1' class='gform-field-label gform-field-label--type-inline'>Wellness Exam ($46)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.2' type='checkbox'  value='Microchip ($48)'  id='choice_8_25_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_2' id='label_8_25_2' class='gform-field-label gform-field-label--type-inline'>Microchip ($48)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.3' type='checkbox'  value='Heartworm test ($30)'  id='choice_8_25_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_3' id='label_8_25_3' class='gform-field-label gform-field-label--type-inline'>Heartworm test ($30)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.4' type='checkbox'  value='Rabies Vaccine (Dog or Cat) ($15)'  id='choice_8_25_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_4' id='label_8_25_4' class='gform-field-label gform-field-label--type-inline'>Rabies Vaccine (Dog or Cat) ($15)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.5' type='checkbox'  value='DAPP Vaccine (Dog) ($18.90)'  id='choice_8_25_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_5' id='label_8_25_5' class='gform-field-label gform-field-label--type-inline'>DAPP Vaccine (Dog) ($18.90)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.6' type='checkbox'  value='Nail Trim ($18)'  id='choice_8_25_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_6' id='label_8_25_6' class='gform-field-label gform-field-label--type-inline'>Nail Trim ($18)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.7' type='checkbox'  value='Lepto Vaccine (Dog) ($17)'  id='choice_8_25_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_7' id='label_8_25_7' class='gform-field-label gform-field-label--type-inline'>Lepto Vaccine (Dog) ($17)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.8' type='checkbox'  value='Influenza Vaccine (Dog) ($42)'  id='choice_8_25_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_8' id='label_8_25_8' class='gform-field-label gform-field-label--type-inline'>Influenza Vaccine (Dog) ($42)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.9' type='checkbox'  value='Anal Glands ($19)'  id='choice_8_25_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_9' id='label_8_25_9' class='gform-field-label gform-field-label--type-inline'>Anal Glands ($19)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.11' type='checkbox'  value='Bordetella Vaccine (Dog) ($18)'  id='choice_8_25_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_11' id='label_8_25_11' class='gform-field-label gform-field-label--type-inline'>Bordetella Vaccine (Dog) ($18)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.12' type='checkbox'  value='FIV\/Feline Leukemia Test? (Prior to Leukemia Vaccine) (Cat) ($38)'  id='choice_8_25_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_12' id='label_8_25_12' class='gform-field-label gform-field-label--type-inline'>FIV\/Feline Leukemia Test? (Prior to Leukemia Vaccine) (Cat) ($38)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.13' type='checkbox'  value='FVRCP Vaccine (Cat) ($20.60)'  id='choice_8_25_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_13' id='label_8_25_13' class='gform-field-label gform-field-label--type-inline'>FVRCP Vaccine (Cat) ($20.60)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_25_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.14' type='checkbox'  value='Feline Leukemia Vaccine (Cat) ($25.60)'  id='choice_8_25_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_25_14' id='label_8_25_14' class='gform-field-label gform-field-label--type-inline'>Feline Leukemia Vaccine (Cat) ($25.60)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_8_26\" ><legend class='gfield_label gform-field-label' >CPR PERMISSION<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_8_26'>I understand Your Veterinary Practice- requires a CPR status prior to the start of any and all procedures so immediate action can take place in the event of cardiopulmonary arrest during, before, or after anesthesia or anytime in our care. I acknowledge that the attending veterinarian or staff members of Your Veterinary Practice will make every effort to contact me regarding treatment in the case of this unforeseen event. The starting cost of CPR is approximately $400. I understand that there is no guarantee of successful resuscitation.\u00a0<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_26'>\n\t\t\t<div class='gchoice gchoice_8_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Yes, please perform CPR on my pet.'  id='choice_8_26_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_8_26\"   \/>\n\t\t\t\t\t<label for='choice_8_26_0' id='label_8_26_0' class='gform-field-label gform-field-label--type-inline'>Yes, please perform CPR on my pet.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='No, do not perform CPR on my pet.\u00a0'  id='choice_8_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_26_1' id='label_8_26_1' class='gform-field-label gform-field-label--type-inline'>No, do not perform CPR on my pet.\u00a0<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_27\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_27\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >If your pet needs emergency medical attention or becomes ill, our staff will make every effort to contact you. However, if we cannot contact you, we will proceed with minimal acceptable medical care until you can be reached. You will be responsible for any incurred expenses.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_27'><div class='gchoice gchoice_8_27_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.1' type='checkbox'  value='I Accept'  id='choice_8_27_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_27_1' id='label_8_27_1' class='gform-field-label gform-field-label--type-inline'>I Accept<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_28\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_28\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I hereby consent and authorize Your Veterinary Practice to receive and board my pet(s). I understand the hospital will use all reasonable precautions for the safekeeping of the described pet(s), but the hospital will not be held responsible in any manner whatsoever on account of medical situations that may arise, as it is thoroughly understood that I assume all risks. I also understand that hospital personnel are not present continuously after normal business hours. I have read, understand and agree to all provisions of this agreement.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_28'><div class='gchoice gchoice_8_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='I consent.'  id='choice_8_28_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_28_1' id='label_8_28_1' class='gform-field-label gform-field-label--type-inline'>I consent.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_29\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_29\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I fully intent to pick up my pet(s) on the date I have specified. If circumstances change I will notify TRUE COMPANION VETERINARY CARE of the new pick up date and assume responsibility for any additional charges incurred.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_29'><div class='gchoice gchoice_8_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='I accept.'  id='choice_8_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_29_1' id='label_8_29_1' class='gform-field-label gform-field-label--type-inline'>I accept.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_32\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_32\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Cancellation Policy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_32'><div class='gchoice gchoice_8_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='I understand that appointment cancellations less than 24 hours before appointment and\/or no shows will incur a $30.00 cancellation fee.'  id='choice_8_32_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_32_1' id='label_8_32_1' class='gform-field-label gform-field-label--type-inline'>I understand that appointment cancellations less than 24 hours before appointment and\/or no shows will incur a $30.00 cancellation fee.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_30\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_30\" ><label class='gfield_label gform-field-label' for='input_8_30'>Please type your initials.<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_8_30' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_31\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_31\" ><label class='gfield_label gform-field-label' for='input_8_31'>Date Signed<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_31' id='input_8_31' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_8_31_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_8_31_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_8_31' class='gform_hidden' value='https:\/\/713websites.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_8_33\" class=\"gfield gfield--type-signature field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_8_33\" ><label class='gfield_label gform-field-label' for='input_8_33'>Signature<\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_8_33_Container' class='gfield_signature_container ginput_container' style='height:180px; 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