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Lodging Information 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 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
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
My pet has food allergies:
(Required)
Yes
No
If YES, please provide details of the food allergies:
(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 any of the following instead?
Nail Trim
Anal Gland Expression
Ear Cleaning
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.**
(Required)
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)
MM slash DD slash YYYY
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
