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Boarding Consent
Glenolden Animal Hospital
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Boarding Consent
Name
First
Last
Pet Name
Contact Number
Emergency Name & Phone Number
(Must be picked up on date above or hospitalization charges will be applied) **It is hospital policy that ALL Pets are Current on Vaccinations before being admitted** **There will be an office visit charge for ANY Pet that needs Boosters or Exam** You can only opt to “WAIT” for PE, Rabies, Distemper and Bordetella if they are not actually due
Your pet is due for the following services:
Physical Exam-$67
Yes
Wait
Rabies-$26-$32
Yes
Wait
Distemper-$26-$32
Yes
Wait
DA2PPL-$26-$32
Yes
Wait
Dog Bordetella-$29
Yes
Wait
Dog Lyme-$35
Accept
Decline
Annual Worming- $39
Accept
Decline
Leptospirosis- $26
Accept
Decline
Cat Leukemia- $35-$48
Accept
Decline
Heartworm &Tick Disease Test- $63
Accept
Decline
Canine Influenza - $33
Accept
Decline
Wellness Testing- All Include Free Urine
Dogs 1-7yr Preventive Care Blood Work (including heartworm)- $103
Accept
Decline
Dogs >7yr Preventive Care Blood Work (including thyroid & heartworm)- $209
Accept
Decline
Cats 1-7yr Preventive Care Blood Work (including heartworm)- $111
Accept
Decline
Cats >7yr Preventive Care Blood Work (including thyroid & heartworm)- $201
Accept
Decline
Is your pet on any medications at this time?
Yes
No
Please Describe
Need to see the veterinarian for any other reason?
If yes, please describe the following information below
How much and how often does your pet eat?
If you did not bring food what does pet prefer?
Yes
No
Would you like us to run a fecal exam to check for parasites ($42)?
Yes
No
If positive would you like appropriate medications administered for additional charge?
Yes
No
Would you like your DOG to be groomed/bathed while here? Bath $39
Yes
No
If yes, what time will you be picking up?
Would you like your DOG to have a playtime session? ($26)
Yes
No
If yes, how many days?
Boarding can be very stressful for your pet. In the event that your pet becomes anxious do we have your permission to prescribe and administer anti-anxiety medication?
Yes
No
There will be a charge for any meds prescribed. PLEASE NOTE THAT BOARDING CHARGES WILL ACCRUE PER PET PER NIGHT I understand that during the length of stay at Glenolden Animal Hospital unforeseen conditions may arise that necessitate a Veterinary Doctor to examine and/or treat my pet as deemed necessary and desirable by the doctor’s professional judgment. Therefore, I agree to any necessary medications and/or procedures (and their associated fees) that may occur during my pet(s) stay here. ----- Payment for boarding is expected upon pet(s) release ----- Signature below authorizes Glenolden Animal Hospital to perform the above requested, required and recommended procedures as outlined and described above:. I understand interest will accrue on this account at a rate of 1.5% of the unpaid balance per month.
Date
MM slash DD slash YYYY
Signature