Boarding Drop Off Form Owners Name:Pet’s Name:Best Phone # :Alternative Phone #Emergency Contact (Name) First Last Emergency Phone**In an emergency situation, if you are not able to be reached at either of these two phone numbers, you authorize our veterinarians to provide any necessary medical treatment for the wellbeing of your pet(s) and you agree to be responsible for all charges related to that treatment. InitialsDo you prefer text when services completed? Yes No OPTIONAL SERVICES Nail Dremel $10 Cuddle Time $5.25 One-on-One Play $5.25 Extra Outside Time $5.25 Select AllDid you bring medications to be given while boarding? Yes No MedicationsPlease describe any bedding, towels, toys, etc. you are leaving with your pet:Did you bring your own food with you? Yes No How many times a day do you feed your pet? How much (QUANITY)?Does your pet have food allergies? Yes No Our records indicate your pet is due for the following:Initials for approval or who to call for permission.Name First Last Phone NumberMay we post your pet’s photo on social media (ie Facebook, Instagram)? Yes No If necessary for medical care, do we have permission to sedate your pet? Yes No Are there any problems your pet might have of which we should be aware?6. Would you like for your pet to have any of the following before going home? Bath Special Shampoo? Nail Trim Dremel Anal Glands (If bathed on the day they are going home, please pickup after 3pm)To effectively diagnose and treat many conditions, diagnostics such as x-rays, blood work, and other procedures may need to be performed. We will notify you by phone, ask for your permission to treat, and provide an estimate before undertaking these diagnostics. *I also authorize RHAH to dispense Capstar—a safe, proven flea control medication for an additional $9.00 (under 25lbs) or $10.00 (over 25lbs) if any evidence of a flea infestation is noted on my animal. **I understand that late arrival fees will range from $5 to $20, and no-show fees will range from $25 to $40, depending on the breed and amount of time missed. I agree to pay these charges as assessed. For further details, please ask. I HEREBY AUTHORIZE ROCKY HILL ANIMAL HOSPITAL, ITS DOCTORS, AND STAFF TO GIVE STANDARD AND ACCEPTED TREATMENT NECESSARY FOR THE WELL BEING OF MY PET. I AGREE TO BE RESPONSIBLE FOR ANY AND ALL COSTS INCURRED IN CONNECTION WITH ANY TREATMENT DURING A GROOMING VISIT. I UNDERSTAND ONLY THE MINIMUM DIAGNOSTICS AND/OR TREATMENT W ILL BE ADMINISTERED TO MY PET UNTIL I CAN BE CONTACTED FOR DIRECT AUTHORIZATION. Owner/ Agent Signature:Date MM slash DD slash YYYY
