Leesburg Vet - Online Boarding Consent Form

Client Name *

First

Last

Pet name *

Phone *

Email *

Hospital and boarding policies

Leaving toys, bedding, and other personal items is strongly discouraged. They are difficult to keep track of if cleaned/laundered. Towne Animal Clinic will not replace or compensate for any damaged or lost items, and may remove any items that interfere with our care of your companion. *

Initial

Boarders must be current on: Rabies, Distemper, & Bordetella (Dogs) or Rabies & Distemper (Cats/Ferrets). If any of these are not current or verifiable, they will be given. If fleas or ticks are found upon admission, your pet will be treated. Fees for vaccinations, flea/tick treatment, boarding and administration of medications are due at the time of discharge. *

Initial

We will try to contact you about major problems, but if minor problems are found or occur while boarding, do we have your permission to treat them without contacting you? *

Initial

If, to maintain proper hygiene, your pet requires frequent bathing or bedding changes due to cage soiling, an additional fee of $10 per day will be added to boarding fees. *

Initial

This facility does not have 24 hour supervision. If your pet is hospitalized and needs constant supervision, he or she will be transferred to an overnight care facility. *

Initial

Pick up times:

M-F 9:00AM - 7:30PM (12:00PM - 8PM if bath is given)

Sat 9:00am - 12:30PM and Sun: Closed

Planned Pick Up Date *

Planned Pick Up Time *

I authorize indicated procedures and assume full financial responsibility for fees incurred while my pet is boarding at Towne Animal Clinic.

I understand that any balance due must be paid at discharge and that I am responsible for any and all collection and attorney fees associated with unpaid charges and returned checks.

What do you feed your pet:

Brand *

Quantity *

Times Per Day *

What medications will we be administering while your pet is here:

Medication *

Milligram *

Quantity *

Frequency *

Add More Medications *

Yes
No

Medication *

Milligram *

Quantity *

Frequency *

Add More Medications (copy) *

Yes
No

Medication *

Milligram *

Quantity *

Frequency *

When is the next dose of medication due? *

Any special notes regarding your pet’s behavior or normal routine we should be aware of: *

Procedures to be completed while your pet is staying with us: check all that apply *

List any other medical procedures to be performed while boarding: *