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Owner's Name (first and last):

Pet's Name:

Email Address:

Primary Contact Phone:

Alternate Contact Phone:

Breed:

Sex:

Age:

Drop Off Date:

Pick Up Date:

Approximate Pick Up Time:

Hospital Name:

Hospital Phone Number:

Treatment Consent:

Treatment Consent:

*** In the very rare case of life threatening illness, we will always stabilize your pet and contact you immediately.***

For purposes of consent for further urgent treatment beyond stabilization (please choose all that apply):

Please call me at my primary contact number to get consent for further treatment
If you are unable to reach me, I give permission for my alternate contact to give consent for further treatment

If unable to reach either contact during an emergency:

I give my consent for the doctor on duty to fully treat my pet
I do NOT give my consent for any further treatment beyond stabilization until I can be reached

Boarding Notes

Boarding can sometimes be a stressful event and cause a patient to have diarrhea, occasional vomiting, and/or not eating.

In these instances: I give Clayton Animal Hospital permission to treat my pet symptomatically. If the event becomes more serious and continues after the initial treatment has been started a doctor will call you to discuss next steps in treatment.

I give permission for treatment
I DO NOT give permission for treatment

Belongings

Belongings:

I understand that it is my choice to have personal belongings in the kennel with my pet during the duration of their stay at Clayton Animal Hospital. I take full financial responsibility if my pet is to consume any amount of any belongings, acknowledging this may include: inducing vomiting, x-rays, medication, and surgery. It is also understood that my pet is unable to be monitored at all times, and that consumption can occur overnight. I also release financial responsibility if any personal objects are damaged or lost.

I would like Clayton Animal Hospital to provide my pet with blankets/bedding while boarding.

I do not give permission for Clayton Animal Hospital to provide my pet with blankets/bedding while boarding.

I would like Clayton Animal Hospital to put the personal belonging I have brought in the kennel with my pet.

Feeding Instructions:

Feeding Instructions:

Will you bring your own food?

If yes, what brand?

Feed Amount, AM

Feed Amount, Lunch

Feed Amount, PM

Are you bringing treats?

If yes, how many treats should be given in AM / PM?

If your pet is not eating the food that you provide do you give Clayton Animal Hospital permission to try food provided by the hospital? This would include I/D wet (a food for sensitive stomach) or Chicken added to the food.

I give permission to feed food provided by the animal hospital if my pet is not eating
Only feed my food and call me if my pet is not eating

Medical Information:

Medical Information:

Does your pet have any current medical conditions?

If yes, please list:

List any medications your pet is currently taking (Include dose and frequency given)

Additional Services:

Please choose any a la carte services you’d like your pet to have:

Playtime 15 min:

Bath (includes ear cleaning and nail trim):

Nail Trim Only:

Grooming (by appointment only - Is your pet scheduled for grooming?)

Signature:

Today's Date: