Please note: We will be closed on Friday, September 25th from 8:30am-10:30am for our monthly staff meeting and training.

Please note: We will be closed on Monday, September 7th in observation of a national Holiday .

For Current up to date information about the New World Screwworm, Please visit: New World Screwworm Outbreak | New World Screwworm | CDC or Screwworm.gov | Unified Government Response To Protect the United States

Lodging Information Form

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This field is for validation purposes and should be left unchanged.

Today's Date(Required)

Owner's Name(Required)

First Last

Email(Required)

Phone(Required)

Patient's Name(Required)

Check-In Date(Required)

Check-Out Date(Required)

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

If yes, what over the counter and or prescription medications are required 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

If yes, what is the brand of food you will be bringing?(Required)

If yes, how often?(Required)

Once daily

Twice daily

Three times daily

AM

PM

If yes, how much do you feed your pet?

Cup

Scoop

Can

If yes, please list any other food additions and how much here. Examples are cottage cheese or green beans.(Required)

If no, Country Friends will provide your pet(s) with hard or canned food (EN, OM, or Recovery). I realize that any CFVC canned or hard food given to my pet(s) will incur additional charges(Required)

I accept

If my pet is not eating and we are unable to reach you, I give Country Friends Veterinary Clinic permission to provide my pet with canned food (EN, OM, or Recovery). I realize that any CFVC canned pet food given to my pet will incur additional charges.(Required)

I accept

My pet has food or other allergies(Required)

Yes

No

If yes, please provide details of the allergies:(Required)

Country Friends Veterinary Clinic loves spending time with lodging pets. We prioritize our responsibility to care for all pets over tracking personal items - please choose to leave valued personal items at home. CFVC reserves the right to remove any item determined to be unsafe and is not responsible for the condition or return of personal items. Country Friends will provide lodgers with blankets and bowls during their stay. Acknowledging these risks, will you be bringing any belongings with your lodging pet?(Required)

I accept

CFVC requires that all aggressive behaviors are reported at the time of check-in. Does your pet have triggers and or aggressive behaviors to be aware of. (Examples are human or kennel aggression.)(Required)

Yes

No

If yes, please describe the triggers and or aggressive behaviors your pet(s) exhibit.(Required)

If scheduling permits, would you like for your pet to have a bath during their stay?(Required)

Yes

No

If yes, I realize that my pet(s) will be bathed and ready for pick-up by 3pm and that I will receive a phone call or text to notify me when they are ready to go.(Required)

I agree

If no, would you like a nail trim, anal gland expression, or ear cleaning instead?(Required)

Yes

No

If yes, please enter the service you would like for us to provide for your pet(s)(Required)

Treatment Authorization(Required)

If I am unable to be reached, I AUTHORIZE CFVC to provide necessary medical treatment and or emergency care. If you choose "yes" an additional section will be provided with more information

If I am unable to be reached, I DO NOT AUTHORIZE CFVC to to provide necessary medical treatment and or emergency care during my pet's stay

My emergency contact's first and last name:(Required)

First Last

My emergency contact's phone number:(Required)

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.

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.

**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.**

I understand and agree.

REQUIRED NOTICE TO ALL CLIENTS: LACK OF FIRE SUPPRESSION AND OVERNIGHT STAFFING Country Friends Veterinary Clinic (the "Facility"), as is allowed by Texas law, is not equipped with an on-site fire suppression sprinkler system and does not routinely employ on-site personnel during the hours of 7 pm - 6:30 am. All animals boarded at the Facility may be left unattended during those times. HOWEVER, THE FACILITY DOES HAVE FIRE AND SECURITY SYSTEMS THAT ARE MONITORED AND CONNECTED TO THE LOCAL FIRE DEPARTMENT. Throughout the hospital and lodging area we are equipped with fire extinguishers. These extinguishers are inspected by the fire marshal as required by law.(Required)

I understand and agree.

I have read the above and acknowledge responsibility for the choices I have selected. I may have a copy of this form upon request. (Signature)(Required)

Today's Date(Required)

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