Boarding Form

Thank you for choosing to work with the compassionate veterinary staff at Rose City Veterinary Hospital! Please complete the Boarding Form below prior to your visit. For additional information, or to schedule an appointment, please contact our office: (503) 232-3105.

Drop-Off Date*

Drop-Off Time*

(between 9AM-5PM)

Pick-Up Date

Pick-Up Time*

(between 9AM-5PM)

Pet Name*

Breed*

Color*

Emergency Treatment Authorization Medical Illness Policy: One of the advantages of boarding your pet at a veterinary hospital is that veterinary attention is available should the need arise. If one of your pets becomes ill, we will call the emergency numbers listed below regarding your pet’s symptoms, treatment options, and an estimate of costs. If, however, no one can be reached please indicate your wishes below:**

Yes, please perform any services the veterinarian deems necessary for the best care of my pet until someone can be reached. This includes only non-elective treatments and any necessary diagnostics.

No, do not provide any medical treatment, even in a life threatening situation, until specific authorization is given.

I authorize up to the amount below in medical care until someone can be reached*

Please initial*

To ensure the health and safety of your pet, we require the following: (Please check each box to acknowledge)*

We flea comb all boarding pets. If fleas are found, flea treatment will be applied and billed to you.

We need proof of current vaccinations/titer: We will update your pets vaccines and/or titers if medical records indicate they are due.

Dogs must have current – DHLP-P (or titers), Bordetella, Rabies, Influenza and fecal.

Cats must have current – FVRCP, Rabies and fecal.

All pets must be spayed or neutered.

There is a $7.00 charge per dose of medication administered (maximum charge of $14.00 per day).

Services desired while boarding:

Nail Trim – Dogs: $35 Cats: $22 (We are not able to perform nail trims for pets that are only boarding Fri-Mon)

Kong Treat (dogs only) - To help alleviate boredom we can give your pet a treat-filled Kong toy once a day for an additional $4/day.

Massage - Certified Animal Massage Therapist Rubi Sullivan can provide a 60 minute session for your pet during their stay for an additional $95/hour. Authorization from your pet's primary DVM is required.

Please answer the following questions concerning your pet's present health:

Pet showing the following symptoms may not be allowed to board. These are (but not limited to) the following: Coughing, sneezing, diarrhea, vomiting, discharge from eyes or nose, lethargy, ringworm, mites, overall poor health and/or positive test results for any viral or parasitic infections.

Has your pet shown any recent signs of:

Diarrhea

Vomiting

Sneezing

Coughing

Have there been any other unusual symptoms we should be aware of while boarding your pet?

I consent to the release of photos of my pet for use on Rose City Veterinary Hospital's website and Facebook page.

Emergency Treatment Authorization

Medical Illness Policy: One of the advantages of boarding your pet at a veterinary hospital is that veterinary attention is available should the need arise. If one of your pets becomes ill, we will call the emergency numbers listed below regarding your pet’s symptoms, treatment options, and an estimate of costs. If, however, no one can be reached please indicate your wishes below:*

Yes, please perform any services the veterinarian deems necessary for the best care of my pet until someone can be reached. This includes only non-elective treatments and any necessary diagnostics.

No, do not provide any medical treatment, even in a life threatening situation, until specific authorization is given.

I understand that boarding pets are not supervised between the hours of 8:00pm and 6:00am. I fully intend to pick up my pet on the date specified and pay in full at time of pick up. If circumstances change I will notify the hospital. I have read the foregoing and agree.

Owner's Signature

I understand this is a legal representation of my signature:*

Emergency Contact Phone Number*

Would you like to receive updates via text periodically? We are not able to send texts on the weekend.*

Yes

Best Phone Number to Text

I authorize the following person(s) to pick up my pet on my behalf:

Tell Us About Your Pet

Medical Concerns / Allergies:

Behavioral Concerns:

Belongings from home (please be very detailed):

Food
We are happy to feed your pet gastro diet dry food at no additional charge, or you may bring your pet’s diet from home.

What food will be fed during stay?*

We provide house food

You bring your own

If you are bringing your own, what is the type of food?

How many times a day?

Morning:

Noon:

Evening:

Amount per meal:

Do you regularly give your pet treats?*

Yes

Do you give your pet vitamins or supplements?*

Yes

Medications: Please list your pets current medications below. Include Heartworm & Flea Prevention.

Flea Medication Name:

Date Last Dose Applied:

Does your pet take any other medications?*

Yes

If yes, please let us know which medications. Include strength & dosage.

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