Date*

Name

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Please list best phone to reach you while your pet is boarding.

Alternate Phone

List alternate phone number to reach you, if available.

Email

Pet's Name*

Species*

Breed

Boarding Check IN Date*

Boarding Check OUT Date*

If you have more than one pet boarding, do you want them boarded together or separate? (Dogs with dogs and cats with cats ONLY)*

Do your pets need any services during their stay with us? We do require a current Exam, Distemper, Rabies and Fecal to board with us. 😊*

What brand & type of diet do you feed your pet?*

We do recommend that you bring your food from home, but if no food is provided or if your pet develops GI upset while boarding, we have Blue Buffalo GI dry food to offer your pet.

Please describe how often you feed your pet and what quantity.*

For example, "1/2 cup of dry food twice a day."

Is there anything we can do to make your pet's stay more comfortable? Likes & Dislikes?*

We offer soft blankets, cage curtains if needed, synthetic calming pheromones, and calming music during their stay. We encourage you to bring something familiar from home to help keep your pet at ease.

Is your pet on medications or supplements? If so please list each individually below. Be sure to include Full Medication name, dosage and frequency given.*

For example, "Thyroxine, 1 tablet in the morning, 1 tablet at night."

Please describe what belongings you have brought with your pet.*

For example, a beige cat carrier, red ball, blue and white bed.

Does your pet have any *SPECIAL MEDICAL CONDITIONS*?*

For example, diabetic, seizures, sensitive stomach, allergy to chicken, etc.

Is there anything else you can tell us about your pet or anything else we should know?*

This is where you can list any special notes or instructions for your pet while in our care.

DOG WALKING POLICY CONSENT*

I have read, I understand & agree to this policy.

PLEASE READ our DOG WALKING PROTOCOL closely to determine how you feel we can best provide your pet with a comfortable, safe experience while boarding at our hospital. Once you have consented to our Dog Walking Policy, then you may select Option 1 or Option 2 (see below).

The dog walking options are as follows:
1) Dog is walked ON LEASH at all times.
OR
2) Dog is allowed to have attended “OFF LEASH access” to the dog yard. I understand that by choosing this option there are inherent risks (however small) due to the proximity to Interstate 81. I also ensure, to the best of my knowledge, my pet does not dig under nor climb or jump over fences.

Hanging Rock Animal Hospital has a spacious back yard for our patient’s enjoyment. It is enclosed with a 6 foot fence. The fencing goes to the ground surface, not into the ground. Our fence does not have a lid or lip. With our proximity to the interstate, our hospital policy is to walk all animals in the yard on a leash. Under some circumstances and per pet owner request, we can allow your pet “off leash access” to our yard. If a patient is allowed off leash they will still be attended at all times by one of our team members.

Dog Walking Protocol*

OPT 1: Walk my dog ON LEASH at all times.
OPT 2: Allow my dog supervised OFF LEASH access to the back yard.

Consent*

I have read, I understand & agree to this policy.

In order to protect your pet and our other patients we require all animals in the hospital to be CURRENT on an EXAM and DISTEMPER & RABIES vaccines and have had a negative FECAL within the past year. If your pet is not up to date on these procedures they will be updated during your pet’s stay. These procedures are at an additional cost.

All pets are checked for fleas upon admission. If fleas are seen on your pet, he/she will be treated while in the hospital. These treatments are at an additional cost.

To minimize digestive tract upset, we recommend bringing your pet’s regular food. For animals on prescription diets, we request you bring the food. Additional charges will apply if we need to provide a prescription diet.

EMERGENCY AUTHORIZATION*

If your pet becomes ill during their stay at Hanging Rock Animal Hospital, the hospital will try to reach the owner and Authorized Emergency Contact (listed above) before providing any medical treatments. In the event that neither the owner nor Authorized Emergency Contact person can be reached, I hereby authorize HRAH to do the following:

DO perform diagnostic tests and treatments deemed medically necessary to restore health.
Do NOT run diagnostics or perform medical procedures except those deemed medically necessary to treat a life-threatening illness.

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