785-823-2217

Home
Our Hospital
Services
New Clients
- Client & Patient Forms
- Payment Options
Online Pharmacy
Contact Us

Home » Client & Patient Forms » Boarding Release Form

Boarding Release Form

Owner Name(Required)

First

Last

Pet Name(Required)

First

PROOF IS REQUIRED IF VACCINES ARE CURRENT.

All pets must be current on required vaccinations. If they are not current and no proof is provided I understand that these vaccines will be administered at my expense.

Canine Vaccines/Lab Test

Vaccine Wellness Examination

I accept

Rabies

I accept

Current

DHP/P-L4

I accept

Current

Distemper/Parvo/Lepto

I accept

Current

Bordetella

I accept

Current

Fecal (Stool Sample)

I accept

Current

Influenza N2/N8

I accept

I decline

Heartworm Test

I accept

I decline

Current

Feline Vaccines/Lab Test

Vaccine Wellness Examination

I accept

Rabies

I accept

Current

Fecal (Stool Sample)

I accept

Current

Distemper (FVRCP)

I accept

I decline

Current

Leukemia

I accept

I decline

Current

Canine/Feline Annual Blood Work

I accept

I decline

Current

Feeding Instructions

(type of food, how much, and how often)

Does your pet need any medications while boarding?

Yes

If yes additional charges will be applied

If yes please give names of any medications and the dosage to be given:

Emergency Phone

REQUIREMENTS FOR BOARDING

All pets must be free of external parasites (ex. ticks, fleas, etc.), or they will be treated at owner’s expense.

If we observe your pet experiencing fear, anxiety or stress, we have your permission to treat your pet accordingly. This may include giving your pet medication which will be an additional cost.

Yes

Call me

If one of your pets becomes ill, we will call the emergency number above regarding your pet’s symptoms, treatment options, and estimate of additional costs. If no one can be reached, however, please indicate your wishes below should your pet require treatment to relieve immediate discomfort or to resolve an important medical condition.

Town & Country Animal Hospital has my permission to do whatever is necessary should an emergency arise.

Do not administer any medical treatment until specific authorization is given.

I authorize up to

$100

$250

Other

Pets may be picked up between 8:00 am – 5:30 pm Monday through Friday, and 8:00 am – 11:30 am on Saturday. Personal items may be left at your own risk. We are not responsible for loss or damage.

We require payment in full at the time of service.

Payment Methods: Cash, Check, Visa, MasterCard, Discover, American Express or Care Credit (Some conditions apply and subject to credit approval)

By typing my full name in the space below I hereby certify that I have read the boarding requirements and understand the hospital's policies. I agree to the foregoing terms of payment and I understand that this constitutes an electronic signature(Required)

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.