Name *

First

Last

Email *

Phone *

Check-In Date *

Pick-Up Date *

Please note, pets getting bathed on the pickup day will be ready after 4 pm.

Approximate time of pick up?

INITIAL HERE: Pick up times are 7am-5:30pm Monday through Friday and 8am-11:30am on Saturday. We are closed Sunday. *

Pet Information

Pet's Name *

Species *

Dog
Cat

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Vaccination Requirements: To ensure the protection of all pets under our care, your pet must be current on the following (proof must be provided by client at time of drop off*) & will be given if current status cannot be confirmed: DOGS: Exam/Rabies/DHPP(Distemper)/Bordetella (Kennel Cough) CATS:Exam/Rabies/FVRCP(Distemper) DOGS & CATS: Proof of a negative fecal test within the last six months and an exam by one of our veterinarians in the last year *Only Vaccinations administered by a licensed veterinarian are recognized*

Greenwich Veterinary Center is a flea and tick free environment. We reserve the right to treat your pet for fleas or ticks at your expense while your pet is staying with us. *

I have read and agree

Medical Illness Policy: One of the advantages of boarding your pet at a veterinary hospital is that medical attention is available should the need arise. If your pet becomes ill while boarding, we will call the emergency number(s) listed above regarding your pet's symptoms, treatment options, and estimate of additional cost. 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. *

I authorize any amount necessary for the treatment of my pet until someone can be reached.
I authorize a maximum amount to be used towards my pet's care until someone can be reached.

Specify maximum amount: *

Did you bring food for your pets? *

Yes
No, please feed food supplied by hospital

If you have not provided food, your pet will be fed Purina Proplan EN Gastroenteric Veterinary Diet (canine and feline formulas).

If yes, what brand? *

Please list feeding instructions: *

When is your pet due for their next meal? *

Pet Medications

Is your pet currently taking any medication? *

Yes
No

If yes, please list medication names *

If yes, please tell us the medication name, dosage & frequency (example: Rimadyl 75mg, 1/2 tablet every 12 hours) *

If yes, when was the last dose given? *

Do you need a refill on this prescription? *

Yes
No

Is your pet taking any other medication? *

Yes
No

If yes, please list medication names *

If yes, please tell us the medication name, dosage & frequency (example: Rimadyl 75mg, 1/2 tablet every 12 hours) *

If yes, when was the last dose given? *

Do you need a refill on this prescription? *

Yes
No

Is your pet taking any other medications? *

Yes
No

If yes, please list medication names *

If yes, please tell us the medication name, dosage & frequency (example: Rimadyl 75mg, 1/2 tablet every 12 hours) *

If yes, when was the last dose given? *

Do you need a refill on this prescription? *

Yes
No

Are you leaving any of the following? (Please check all that apply) *

If other, please specify *

Would you like your pet bathed before going home? (If yes, pick-up is after 4 pm) *

Yes
No

Would you like your pet to receive extra play-time while here boarding? ($5.00 extra per day) *

Yes
No

In case of an emergency, would you give us your permission to resuscitate? *

Yes
No

Please check all that apply during your pets' stay:

My pet needs his/her Annual Exam, Vaccinations, Routine Bloodwork, and/or Fecal Exam updated
My pet will be having a surgical or dental procedure while boarding
My pet needs to be seen by the veterinarian for ____

My pet needs to be seen by the veterinarian for: *

Please complete our Procedure Consent Form.

Kennel Cough Disclaimer*

Kennel Cough is an umbrella term for a variety of viruses and bacteria that can cause infectious cough/nasal discharge and congestion in dogs. Bordetella Vaccine is required for all of our boarding patients, but unfortunately, there are other viruses and bacteria that can cause Kennel Cough that there is not a vaccine for.

Similar to sending children to school or daycare, as pets congregate there is the possibility that an asymptomatic dog could spread disease prior to showing any clinical signs. Our policy is that any pet that has a cough, nasal discharge, or congestion that could be due to an infectious cause is not able to board at our facility. What we cannot control is the asymptomatic pet that may spread disease prior to showing clinical signs. We do everything possible to eliminate any infections arising from our kennel by avoiding dog-dog contact, thoroughly washing runs, washing bedding daily, and having employees wash hands between pets. Our ventilation system provides excellent airflow to help decrease respiratory pathogens.

If you have a boarding reservation with our kennel, and your pet has developed a cough or nasal discharge please call our office as we will need to have one of our veterinarians examine your pet prior to admittance to boarding. We will not be able to accept patients for boarding that are suspected of having kennel cough. In the event that any of our boarders develop a cough or nasal discharge while boarding, we will contact their owner to advise them of the situation and the patient will be moved into our isolation ward until they are able to be picked up by their owner.

If your pet develops any signs of kennel cough (lethargy, cough, nasal discharge, or congestion) following boarding, please call our office. One of our veterinarians will determine how to proceed with their care. Please know that the majority of these cases are very mild in vaccinated patients. If your pet is due for a Bordetella vaccine, the sooner it is administered the better prior to boarding for protection from Bordetella.

Bordetella is very rarely a problem for cats or people but has the potential to affect immune-compromised individuals. If your pet is diagnosed with kennel cough, please discuss any concerns about immune-compromised individuals in the house with your veterinarian.

Signature *

Date *

Boarding Consent Form

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