Boarding Information and Authorization Form Today's Date(Required) MM slash DD slash YYYY Owner's Name(Required) First Last Email(Required) Phone(Required)Patient's Name(Required) Check-In Date(Required) MM slash DD slash YYYY Check-Out Date(Required) MM slash DD slash YYYY Please provide the following details so that we can provide desired accommodations:Is your pet currently on any medications aside from prevention?(Required) Yes No What medications are they on and how often are they administered?(Required)Pet prescriptions will have an additional medicine administration daily charge.(Required) I accept Will you be bringing your own food?(Required) Yes No How often and how much do you feed your pet?(Required) If my pet is not eating, I give Country Friends Veterinary Clinic permission to provide my pet with canned food (EN, OM, or Recovery) without contacting me first(Required) I accept I realize that any CFVC canned pet food given to my pet will incur additional charges(Required) I accept My pet has food allergies:(Required) Yes No If YES, please provide details of the food allergies:(Required) Country Friends provides boarders with blankets and bowls during their stay. Will you be bringing any additional belongings?(Required) Yes No If YES, please list the items that you will be bringing. Please note that some toys/treats may be considered unsafe to have during unsupervised time periods and Country Friends reserves the right to keep certain items away from boarders.(Required) If scheduling permits, would you like for your pet to have a bath during their stay?(Required) Yes No I realize that my pet(s) will be bathed and ready for pick-up 3pm and that I will receive a phone call or text to notify me when they are ready to go.(Required) I accept If my pet needs medical attention during his/her stay, Country Friends Veterinary Clinic 1. HAS 2. DOES NOT HAVE permission to provide medical assistance (CFVC will make every effort to reach our clients prior, if possible. I understand that all medical treatment will incur additional charges.(Required) Has Does not have I understand FULL payment for all procedures done on (or not on) the treatment plan is due on the date or at the time of the pet(s) release. Any estimate of charges or fees for presently planned procedure(s) is only a best approximation and the final invoice may be greater or less than the stated estimate.(Required) I understand I understand all animals admitted must be current on vaccinations and be free of external parasites. Animals not in compliance with the above policy will be treated at owner’s expense.(Required) I understand **I understand that’s animals that are too young to have completed all sets of puppy/kitten vaccines or elderly dogs/cats that have suspending their vaccines due to doctor recommendation are at a higher risk of contracting contagious diseases despite our best efforts to prevent this occurrence.**(Required) I understand I understand that my pet(s) will be in a safe environment and staff WILL NOT be present from 7pm-7am on weekdays and staff WILL be present 7am-9am and 5pm-7pm on weekends and or holidays.(Required) I understand Any estimate of charges or fees for presently planned procedure(s) is only a best approximation and the final invoice may be greater or less than the stated estimate.Please list any emergency contacts(Required) I have read the above and acknowledge responsibility for the choices I have selected. I may have a copy of this form upon request.All fees for services are due when the patient is released.Signature(Required)Today's Date(Required) MM slash DD slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
Please provide the following details so that we can provide desired accommodations:
Any estimate of charges or fees for presently planned procedure(s) is only a best approximation and the final invoice may be greater or less than the stated estimate.
I have read the above and acknowledge responsibility for the choices I have selected. I may have a copy of this form upon request.
