Medical Boarding Release

If you would prefer to print and manually fill out this form please contact our office at 804-739-7892 or This email address is being protected from spambots. You need JavaScript enabled to view it. and we would be glad to send you a downloadable version of our Medical Boarding Release Form.

Any pets on specialized diets or with sensitive stomachs should bring their own food labeled with their name(s) and instructions.

All medications should be brought in containers and properly labeled with name of pet(s), name of medication, dosage, and instructions.

Medications cannot be crushed or mixed in with food.

I understand you CAN NOT guarantee the health of my pet. I understand and will not hold the clinic responsible for conditions that are unavoidable in boarding kennels, such as but not limited to weight loss, hair loss, upper respiratory infections, bronchitis, diarrhea, and fleas. I understand all pets admitted to the clinic must be protected against communicable contagious diseases and must be free of internal and external parasites or will be treated on entry or discovery at the owner/agent’s expense.

I understand that in the event of my pet’s illness, the staff will immediately attempt to contact me or my agent to discuss the problem and treatment options, but may not be able to contact me immediately and is therefore authorized to initiate appropriate treatment until I can be reached.

In the event a problem is observed or develops while boarding CHOOSE ONE of the following options:
(If your pet needs additional care we will contact you as quickly as possible.)

Please treat my pet as required, you need not call me.

Please treat my pet as required up to [amounts will appear below]:

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$150

$300

$500

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Should an EMERGENCY arise, I authorize the medical staff to sedate my pet and/or perform such emergency procedures as may be necessary for the health of my pet until I can be notified. I agree to pay, in full, all charges for necessary services rendered.

I understand that the clinic is not responsible for loss or damage to personal items left with the pet including but not limited to leashes, collars, toys, and bedding.

The clinic is to use all reasonable precaution against injury, escape, or death of my pet. The clinic and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed. I understand that any problem that develops with my pet he/she will be treated as noted above and I assume full responsibility for the treatment expense incurred.

I will call if my “pick-up date” changes so you can plan accordingly.

Please list any additional treatment(s) you wish for your pet to receive during his/her stay. Please note prices for these treatments are not included in boarding and will be at an additional cost. (Examples: Spay, Neuter, Vaccinations, Toenail Trim, Anal Glands, Bath, etc...):

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Please note any food/diet instructions for pet while boarding, how often normally fed (i.e. AM only, PM only, AM & PM), how much fed per meal, AND when the pet was last fed before drop off:

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Pet Name(s):

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Drop-Off Date:

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Pick-Up Date:

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Owner's Contact Number(s):

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Owner's Email:

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Alternate Emergency Contact Name:

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Alternate Emergency Contact Number:

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I understand and accept the policies listed above.

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Please enter your full name in the textbox below to accept the above policies.(*)

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Confirmation of Electronic Signing:(*)

I understand that by typing my name and clicking on "Submit", I am electronically signing this document.

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Today's Date

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Downloaded?

Yes

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