Boarding Check-in Form – Veterinarians Waterford, Michigan

Name*

First Last

Phone*

Email*

Pet's Name*

Pet's Breed*

Pet's Weight:*

Check-in Date*

Check-out Date*

Drop off time*

Pick up time*

Drop Off and Pick Up Times:
Mon-Friday 9 am-12 pm & 2-5 pm
Sat 9 am-12 pm
Sun pick up only 6 pm-7 pm

(248) 673-1288

Due for Services/Vaccines:*

Heartworm Preventative Type/Qty:*

Flea/Tick control Type/Qty:*

If not current on Prev/fleas present-Capstar treatment will be used @ the cost of: 0-25 lbs $6.50 Over 25 lbs $7.00 K9 Advantix (prev/ treatment) $21.50-$23.00

Last Application:*

Diet & Feeding Instructions:*

Would you like to request extra walks, if so how many?*

Additional Walks (walked 3 X per day) $4 per extra walk

Please list all belongings you are dropping off with your pet:*

Please check all additional services you would like while your pet boards with us:*

Bath
Pedicure
Frosty Paws $3.25 each
None

Additional services will be added to your boarding bill.

Please check all updates you would like while your pet boards with us:*

Text Update
Picture
Progress Report
Progress Report Call After Stay

Does your pet need any medication administered while they board with us?*

Yes
No

Medications/Instructions:*

1-3 Medications $1.00 per day Over 3 Medications $3.00 per day

Special Instructions:*

Special Handling (medical needs, aggressive animals, etc.) $5.00 per day

*

I hereby grant permission to Pet Authority boarding establishment to act in my behalf, and in my pet's best interest, by obtaining veterinary care at my expense, if deemed necessary, for illness or injury. I further agree to pay for all veterinary and other necessary services incurred by my pet during the stay.

IN THE EVENT OF A NON LIFE-THREATENING ILLNESS, I WISH TO BE CALLED BEFORE ANY TREATMENT OR DIAGNOSTICS ARE PERFORMED*

Yes
No

Example: Stress diarrhea, vomiting, nose rubbing, or broken toenails may occur, and treatment will range from $50-$150 depending on severity or circumstance.

IN THE EVENT OF A LIFE-THREATENING EMERGENCY, I AUTHORIZE TREATMENT TO BEGIN IMMEDIATELY UP TO $_______. I UNDERSTAND I WILL BE CONTACTED IF AN EMERGENCY OCCURS.*

Any cost beyond this amount must be authorized by myself (PET OWNER) or listed emergency contact prior to treatment.

Pet Authority agrees to exercise all reasonable and professional care to prevent injury or illness for my pet. However, in the event of illness or injury, the doctors and employees of Pet Authority shall not be held personally liable for such illness or injury. I agree to pay all cost for any property damage or personal injury caused by my pet during the stay. I agree to pay all charges; stated on the authorization, with the understanding it is an estimate and may not include medications, treatments or other necessary services or products. I also agree to pay all charges on the day of pick up and understand that my pet may not leave the premises until the invoice is paid in full. I understand that any animal left beyond 10 days of agreed pick up date, is considered abandoned. Pet Authority will do what is deemed best for the pet, which will be decided by the owner of the practice.

*

FEES ARE APPLIED IN FULL DAY UNITS REGARDLESS OF CHECK-IN OR CHECK-OUT TIME, AND WILL INCLUDE CHECK-IN AND CHECK-OUT DAYS. A $5 HOLIDAY CHARGE WILL ALSO APPLY FOR THE DAY OF THE HOLIDAY ONLY.

(Example: Friday check-in and Sunday check-out will incur 3 daily charges, and if Sunday was a holiday an additional $5 would be applied)

Signature of Pet Owner or Responsible Party*

Date*

Emergency Contact*

First Last

Emergency Contact's Phone*