Boarding Admission Form
Boarding Admission Form
General Information
Today’s Date
*
START Date of Boarding Stay
*
END Date of Boarding Stay
*
Client Name
*
Client Name
First Name
First Name
Last Name
Last Name
Phone Number
*
Email
*
IN CASE OF EMERGENCY
Please provide an emergency contact person who is authorized and physically available to make medical decisions on your behalf, INCLUDING POSSIBLE DECISIONS REGARDING EUTHANASIA, for your pet. This should be someone other than yourself or any person(s) accompanying you on your trip. This person should be aware that you are putting their name on this legal document. NHPC will transfer pet(s) requiring emergency medical intervention or critical care to Veterinary Emergency Group (VEG) Oklahoma City. Their facility is located at 13230 Pawnee Drive, Oklahoma City, OK 73114.
EMERGENCY CONTACT NAME
*
An emergency contact is someone who is not accompanying you on your trip and is authorized to make any major medical decision for your pet. Should your pet be transferred to an emergency clinic, this person will be responsible for facilitating your pet’s care.
EMERGENCY CONTACT PHONE NUMBER
*
Feeding Instructions & Medications
Pet’s Name
*
Are you bringing your pet’s own food or would you like for us to feed our kennel diet?
*
Own provided food
Kennel diet
Our kennel diet is Purina Pro Plan Veterinary Diet EN
How much food are you feeding this pet and how often? (ex: 2 cups twice daily)
*
Will you feed your pet prior to drop-off for boarding?
*
Yes
No
Does your pet have any food allergies?
*
Yes
No
Are you bringing medication(s) to be administered to your pet?
*
Yes
No
Subject to a daily medication administration fee
Please list medications (strength, dosage, and frequency of administration)
*
What brand of flea & tick prevention is this dog currently on?
*
When did this dog receive their last dosage of flea & tick prevention?
*
Within the last 30 days
Within the last 3 months
More than 3 months ago
Not currently on a flea & tick preventative
Have you seen any flea, ticks, or parasites on this dog since the last visit?
*
Yes
No
Consent to Treatment
I authorize permission for this pet to receive oral anti-anxiety medication(s) if necessary?
*
Yes
No
Anti-anxiety medications are intended to address specific neurotransmitters associated with fear, anxiety, or stress related to the veterinary setting. The goal is to help make your pet’s stay more enjoyable and less stressful. Medications can help to reduce stress and anxiety so the veterinary team can work to change the way your pet feels about boarding.
I authorize the following monetary amount for additional services outside of the cost of boarding
*
$250
$400
None
Specifically, this is authorizing treatment in the event of minor illness (vomiting, stress diarrhea, etc) while your pet is boarding
Policies & Liability Waivers
Please review and read all policies below
<ul><li>If my pet’s vaccinations are not valid or currently on file with NHPC, I understand that the veterinary staff at NHPC is required by law to vaccinate my pet at my expense during their boarding stay</li><li>If fleas and/or ticks are found on my pet during their stay, my pet will be treated at my expense</li><li>I understand that sick animals are not allowed to board at NHPC. Illnesses should be handled by a veterinarian well in advance to my pet’s boarding stay and should clear of all symptoms prior to their stay.</li><li>I understand that picking my pet up before their scheduled pick up date may results in my pet not receiving their cleansing bath (dogs that have boarded more than 3 nights) or scheduled exams or treatments.</li><li>Aggressive or fearful dogs may not tolerate a cleansing bath. Cleansing baths DO NOT include nail trims, ear cleaning, or anal gland expression.</li><li>I have provided the dates of my pet’s boarding stay at the top of this form. I agree to contact and update NHPC with any changes to my pet’s pickup dates.</li><li>I understand that NHPC will charge additional boarding fees for each additional day outside of the scheduled reservation. My emergency contact may be contacted to pick up and care for my pet during peak holiday boarding dates when space is limited and my pet’s reservation cannot be extended.</li><li>If my pet’s medical or physical condition requires transfer to a critical care or emergency facility, I will be notified by all available contact methods that are currently on file with NHPC. I understand that it is my responsibility to have the above named emergency contact liaison available to facilitate my pet’s hospital care and release. Nichols Hills Pet Clinic will relinquish all medical and financial responsibilities for my pet(s) upon release to the critical care or emergency facility. </li><li>NHPC will transfer to Veterinary Emergency Group (VEG) Oklahoma City. </li></ul>
Signature
*
signature
keyboard
Clear
Submit
If you are human, leave this field blank.
× Close Panel
