Boarding Consent Form for Dogs

Name: Veterinarian
Brand: Orchard Road Animal Hospital

PLEASE CALL THE OFFICE TO SCHEDULE A RESERVATION BEFORE FILLING OUT THIS FORM.

Owner's Name

Owner's Cell Phone

Owner's Email

Dog's Name (Only ONE)

Check-In Time

Check-Out Time

Do you have more than one dog staying with us?

Yes

What food will we be feeding your dog?

Hills Science Diet Adult Maintenance Dry Kibble for DOGS (provided by ORAH no additional charge, although we strongly recommend you bring your normal food)

Royal Canin Gastrointestinal Low Fat Dry Kibble for DOGS (no additional charge)

Other…

Will you be bringing your dog's food from home (recommended)? There will be additional charges for special diets that the hospital provides (e.g. prescription diets, canned food, etc.)

Yes

Other…

If your pet does not eat its regular food while boarding with us, we may try a canned diet while here to encourage eating. We exercise the right to give canned food if deemed best for your pet. There will be additional charges for canned food.

I acknowledge.

How often will we be feeding your dog?

Once in the Morning (AM only)

Once in the Evening (PM only)

Twice Daily (AM & PM)

Thrice Daily (AM, Noon, & PM)

Feed Feed (Food always available)

Other…

How much will we be giving your dog at each feeding? Please provide answer in CUPS (e.g. 1/4 cup, 2 cups, etc.)

Is your dog on any medications, supplements, etc. that we should give while they are here?

Yes

No, we are to feed nothing but the food or treats provided

If your dog is on any medications, supplements, etc., please write the NAME (e.g. Prednisone), the DOSAGE (e.g. 5mg), the INSTRUCTIONS (e.g. "Give 1 tab twice daily"), the DESCRIPTION (e.g. small round white tablet), and IF YOU HAVE GIVEN any medication already on the day of drop off (e.g "Gave AM dose, not yet given PM dose).

I understand that ORAH charges $4.00 per once daily dosing of medications or supplements, and $8.00 for dosing of twice daily or more.

I understand.

We require each dog boarding with us to be a current patient (examined within the last year), have current vaccinations (rabies, distemper, & bordatella), have a negative fecal test within the last year, and have received flea and tick prevention that will last for their entire stay. Which of these do we still need to perform for your pet? (If you do not know, please contact the hospital at 630-844-0100)

Examination ($68)

3-Year Rabies (exam required at time of vaccine) ($52.38 + tag)

1-Year Rabies (exam required at time of vaccine) ($33.48 + tag)

Distemper Combo (exam required at time of vaccine) ($29.16)

Bordatella (kennel cough vaccine) ($31.32)

Fecal Test ($37.45)

Effipro Plus Topical Flea/Tick Prevention One-Time Application ($16.20)

Credelio Chewable Flea/Tick Prevention One-Time Application ($30)

None, my pet is completely up to date on its annual exam, required vaccines, negative fecal test, and flea/tick prevention

If upon check-in, it is discovered that your dog needs required services prior to boarding not indicated on this form, you consent to Orchard Road Animal Hospital providing those services to enable your dog to board. You are financially responsible for all charges incurred.

I acknowledge.

If fleas or ticks are found on your pet during their stay with us, there will be an additional charge for dispensing and treating with whatever medication the veterinarian on call deems appropriate.

I understand.

There are other services we can perform for you while your dog is boarding with us. Would you like any of the following OPTIONAL procedures?

Leptospirosis Booster (exam required at the time of vaccination) ($31.32)

Heartworm Test ($57)

Nail Trim ($25)

Anal Gland Expression ($32.50)

None, no other services requested

Other…

Please list IN DETAIL all belongings you are bringing with your dog (including food, bedding, treats, and medications). We provide food and water bowls.

Please understand that while we try our best to keep belongings safe, we cannot guarantee that your dog won't behave differently while boarding and destroy toys, bedding, etc. Please do not send anything with your dog that is irreplaceable.

I understand.

In the unlikely event of a life-threatening emergency, we will do everything to stabilize your dog immediately. In the unlikely event that an illness or injury is noted with your dog while staying with us, please choose how you would like us to proceed:

I authorize you to examine, treat, and prescribe medication for my dog. I understand that there will be additional charges for this treatment. I do not want to be contacted during my dog's stay.

Please contact the individual listed as the required contact person before any non-emergency treatment or medication is provided.

We require a designated Contact Person who has permission to authorize treatment for your dog. Who can we contact if we need to regarding treatment of your dog and what is their relation to you? (If this person is you, please put your name and "self").

What is the Contact Person's cell phone number? Please list any other numbers or emails we may use to contact this person.

General Information: Our accommodations are available to our current clients on a reservation only basis. Boarders only go outside to play with kennel attendants, not other pets. We are not staffed 24 hours a day; therefore, your pets will be unattended during the evening hours. All precautions will be taken to prevent injury, escape, or other life-threatening emergencies. If you need to extend or reduce your dog’s stay, please contact us immediately. We make every attempt to return all items that you leave with your dog; however, some items may be lost due to changing bedding or cleaning the items. We cannot guarantee the return of your items. Please DO NOT bring belongings that are irreplaceable.

I have read, understood, and agreed to the above rules, regulations, and information about boarding my dog at Orchard Road Animal Hospital.

Pick-Up and Drop-Off Information: Boarders will only be admitted and discharged during business hours. Under no circumstances will guests be released on Sundays or Holidays. If your pet is to be picked up by someone other than yourself, you must make these arrangements, including payment, at the time of drop off. All pets are screened for fleas & ticks when admitted for boarding. If any external parasites are detected, Orchard Road Animal Hospital will promptly treat at the owner’s expense. For each major holiday (New Years Eve, New Years Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day, Christmas Eve, and Christmas Day) there will be an additional $15.00 Holiday Boarding Fee. There is also a 3 day boarding minimum over these dates.

I have read, understood, and agreed to the above rules, regulations, and information about boarding my dog at Orchard Road Animal Hospital.

Emergency Care Information: As the owner or authorized guardian of this animal, I give permission to Orchard Road Animal Hospital (ORAH) to receive, treat, prescribe or otherwise provide care for the dog named above as deemed necessary by the veterinarian on call. Should injury or circumstances warrant the need for emergency service, I understand ORAH will attempt to contact the Contact Person before treatment, but will exercise the option to proceed if no one is available to provide permission.

I have read, understood, and agreed to the above rules, regulations, and information about boarding my dog at Orchard Road Animal Hospital.

Orchard Road Animal Hospital reserves the right to refuse boarding services for medical reasons or otherwise as determined by our team. By signing below, you authorize Orchard Road Animal Hospital to care for your dog while boarding at our hospital. You accept all financial responsibility for any and all charges incurred during your dog's stay.

Sign above

Boarding Consent Form for Dogs

Review Us!

Get In Touch

Orchard Road Animal Hospital