Client Name *

Client Email *

Contact Number *

Patient Name *

Check-In Date and Time *

Date

Time

Check-Out Date and Time *

Date

Time

Food Provided *

Yes
No

Container

Feeding Instructions *

Have they been eating/drinking/acting normally?

Yes
No

If no, please explain *

Have they had any recent bouts of coughing/sneezing/vomiting/diarrhea? *

Yes
No

If yes, please explain *

Has there been any changes in their urination? *

Yes
No

If yes, please explain *

Medications/Supplements?

Yes
No

Name of Medication/Supplement *

Instructions *

Last Given (DATE and TIME)

Date

Time

Additional Medications/Supplements?

Yes
No

Name of Medication/Supplement 2 *

Instructions *

Last Given (DATE and TIME)

Date

Time

Name of Medication/Supplement 3

Instructions

Last Given (DATE and TIME)

Date

Time

Would you like any additional services?

All animals admitted must be current on their vaccinations and free of external parasites. At time of drop off proof of vaccinations must be provided if your pets vaccinations have been done else where, or they will be administered by one of our staff at the owner's expense. Any animal found to have fleas or ticks will be treated at the owner's expense. *

I have read and understand the policy above.

MULTIPLE PET BOARDING: If you are boarding more than one pet, please list pets that can be placed together.

Do your pets need to be separated during feeding time? *

Yes
No

Personal Belongings: Please list all belongings, including food, be specific:

(We provide bedding and food/water bowls)

Boarding Animals General Rules/Regulations/information:

If your pet is to be picked up by someone other than yourself, you must make these arrangements including payment, at the time of drop off.
We are NOT staffed 24 hours a day; therefore, your pets will be unattended during the evening hours.
If you need to extend your pet's stay you must contact us 24 hours before the expected discharge date. In the event that you do NOT pick up your pet within 10 days after the expected date of discharge your pet will be considered abandoned and Blount Veterinary Clinic reserves the right to relinquish care of the abandoned pet to and appropriate agency or offer the pet for adoption. You will still be responsible for all charges.
All animals must be free of external parasite (fleas and ticks) when admitted for boarding, or must be treated upon arrival, at owner’s expense. It is also recommended that all boarding pets should be tested for heartworms and placed on prevention at least one month before boarding time.
Boarding animals will be admitted and discharged ONLY during regular office hours. Our office hours are posted on our website and on the front of the building. We are open Monday-Friday 7:30-6 and Saturday 8-12 NOON. We are closed on Sunday.
Should your pet show any signs of aggression toward our staff or doctors, we reserve the right to terminate any further boarding reservations.
All precautions will be taken to prevent injury, escape and any other life-threatening emergencies. The hospital staff will NOT be held accountable for problems that develop, provided that reasonable care and precautionary measures have been taken.
We make every attempt to return all items that you leave with your pet; however, some times may be lost due to changing bedding or cleaning the items. WE CANNOT GUARANTEE THE RETURN OF YOUR ITEMS.

Policy Agreement *

I have read and understand rules and policies listed above.

Please check one of the following in case a problem occurs: *

I prefer Blount Veterinary Clinic to proceed with any/all needed procedures.
I prefer to be contacted prior to any additional procedures other than emergencies. However, if I cannot be reached, I authorize unseen, non-emergency procedures.
If I cannot be reached, I do NOT authorize and unforeseen, non-emergency procedures.

Date *

Boarding
Consent Form

Boarding Consent Form

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