Going away and need to board your pet? We value your time. Submitting this form will expedite all front desk transactions and improve customer service. This form will be printed at our office when you come in and will need your signature before boarding your pet with us. Thank you for your cooperation and support of Ocala Veterinary Hospital. Your Name:* First Last You Home Address:* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone number where you can be reached.*Email where you can be reached.* Emergency ContactPlease provide an emergency contact.Emergency Contact's Name* Emergency Contact's Phone*Boarding Time InformationPlease let us know the check-in date and check-out date for your pet's stay with us.Check-In Date* Date Format: MM slash DD slash YYYY Check-Out Date* Date Format: MM slash DD slash YYYY Would you like special services for your pet?* Grooming Bath Tracheobronchitis (Kennel Cough) Vaccine Annual Vaccines Heartworm Test Fecal (Intestinal Parasite Exam) Blood Work Surgery / Dental / Anesthesia No special services. Your Pet's InformationPlease provide your pet's information for us so we can make sure your pet is getting everything you would give it at home!Pet's Name*Select Pet SpeciesCanineFelineAvionReptilePocket PetWhat's your pet's breed?What's your pet's gender?MaleFemaleOtherWhat's your pet's age?Your pet's color?Please explain any special needs of your pet.Please list out any special diet, medications or special care instructions or general concerns that we should be aware of while your pet boards with us.Consent to receive and board:Sign & Date in Person:* I understand that I will have to sign and date the printed version of this in person before boarding my pet.. Consent Agreement:* I hereby consent and authorize Ocala Veterinary Hospital to receive and board my animal(s). I understand the hospital will use all reasonable precautions for the safekeeping of the described animals(s), but the hospital will not be held responsible in any manner whatsoever on account of medical situations that may arise, as it is thoroughly understood that I assume all risks. I also authorize the hospital to treat any necessary medical conditions that may require treatment prior to my return. The hospital will make all reasonable attempts to contact the owner or emergency contact person as necessary. I understand that any emergency situations will be managed first prior to contact. Additionally in order to controls fleas in the boarding facility , I understand that a bath and the application of flea control may be required at the owner’s expense. I further understand it is hospital policy that all annual vaccinations be up to date at the time of boarding. Furthermore, the hospital requires all boarding canines(s) receive an intranasal vaccination to help prevent the incidence and spread of kennel cough. These vaccination requirements reduce the risk to hospital employees and improve the general health condition of the boarding facilities. After 3 days from written notice mailed to the address on file in the medical record, requesting removal of the animal from the hospital, it will be considered abandoned and may be disposed of, or destroyed as the hospital deems best, and it is understood that such actions do not relieve me from paying all costs of services and the use of the hospital, including the cost of keeping. Balances due are to be paid when the pet checks out. NameThis field is for validation purposes and should be left unchanged.
