TotalBond Davidson - Express Boarding Check In

1
Thank you for using our Express Check-In process. If your boarding pet(s) will require medication administration or an exam for any reason while boarding, please know that a Veterinary Technician will need to spend a few moments with you at time of drop-off. Please plan accordingly.
2
First Name
Last Name
Phone number where you can be reached while your pet stays with us
Please Select
Please Select
Yes
No
Can you receive text messages?
Secondary phone number
Email address
3
Pet name
4
Please confirm boarding dates* This field is required.(Note: We do not offer Sunday drop-off or pick-up times)
5
Please Select
Please Select
Bath (nail trim included)
Nail Trim only
Anal Gland Expression
Exam
Select any additional services you would like performed while your pet is boarding
Please Select
Please Select
Food from home
Dry food provided by the hospital (Royal Canin Veterinary Diet)
Wet food provided by the hospital (Royal Canin GI Lowfat Veterinary Diet)
What will your pet be eating while they stay with us?
Please Select
Please Select
Free feed (leave food readily available throughout the day/night)
Once daily AM or PM
Twice daily (AM and PM)
How often will your pet need to be fed while boarding?
List any food allergies
How much does your pet eat each meal?
6
If these services were not previously scheduled, add-on baths and nail trims will be based on availability at time of drop-off.
7
Will your pet require any medications to be given while boarding? If so, please list below. *All medications will need to be brought to the hospital in the original prescription bottle with clear, legible instructions. Please be sure to provide enough medication to last the duration of their boarding stay.
Name of medication
Dosing Instructions
Name of medication
Dosing Instructions
Any health concerns or special requests that weneed to be aware of?
8
All pets are taken outside multiple times daily. Boarding pets are taken out individually, or with family members only.
Please Select
Please Select
I give permission for my pet to play outside off leash
My pet must remain on a leash at all times while outdoors
Please choose off-leash permission
Please Select
Please Select
Do everything deemed medically necessary by the Veterinarian on duty to revive my pet
Do only minimal supportive care until I am reached (CPR)
Do not rescuscitate
In the event of an emergency while your pet is in our care, how would you like for us to proceed?
9
Add another pet
YESNO
10
Second pet name
11
Please confirm boarding dates* This field is required.(Note: We do not offer Sunday drop-off or pick-up times)
12
Please Select
Please Select
Bath (nail trim included)
Nail Trim only
Anal Gland Expression
Exam
Select any additional services you would like performed while your pet is boarding
Please Select
Please Select
Food from home
Dry food provided by the hospital (Royal Canin Veterinary Diet)
Wet food provided by the hospital (Royal Canin GI Lowfat Veterinary Diet)
What will your pet be eating while they stay with us?
Please Select
Please Select
Free feed (leave food readily available throughout the day/night)
Once daily AM or PM
Twice daily (AM and PM)
How often will your pet need to be fed while boarding?
List any food allergies
13
If these services were not previously scheduled, add-on baths and nail trims will be based on availability at time of drop-off.
14
Will your pet require any medications to be given while boarding? If so, please list below. *All medications will need to be brought to the hospital in the original prescription bottle with clear, legible instructions. Please be sure to provide enough medication to last the duration of their boarding stay.
Name of medication
Dosing Instructions
Name of medication
Dosing Instructions
Any health concerns or special requests that weneed to be aware of?
15
All pets are taken outside at least 4 times daily. Boarding pets are taken out individually, or with family members only.
Please Select
Please Select
I give permission for my pet to play outside off leash
My pet must remain on a leash at all times while outdoors
Please choose off-leash permission
Please Select
Please Select
Do everything deemed medically necessary by the Veterinarian on duty to revive my pet
Do only minimal supportive care until I am reached (CPR)
Do not rescuscitate
In the event of an emergency while your pet is in our care, how would you like for us to proceed?
16
Add another pet
YESNO
17
Third pet name
18
Please confirm boarding dates* This field is required.(Note: We do not offer Sunday drop-off or pick-up times)
19
Please Select
Please Select
Bath (nail trim included)
Nail Trim only
Anal Gland Expression
Exam
Select any additional services you would like performed while your pet is boarding
Please Select
Please Select
Food from home
Dry food provided by the hospital (Royal Canin Veterinary Diet)
Wet food provided by the hospital (Royal Canin GI Lowfat Veterinary Diet)
What will your pet be eating while they stay with us?
Please Select
Please Select
Free feed (leave food readily available throughout the day/night)
Once daily AM or PM
Twice daily (AM and PM)
How often will your pet need to be fed while boarding?
List any food allergies
20
If these services were not previously scheduled, add-on baths and nail trims will be based on availability at time of drop-off.
21
Will your pet require any medications to be given while boarding? If so, please list below. *All medications will need to be brought to the hospital in the original prescription bottle with clear, legible instructions. Please be sure to provide enough medication to last the duration of their boarding stay.
Name of medication
Dosing Instructions
Name of medication
Dosing Instructions
Any health concerns or special requests that weneed to be aware of?
22
All pets are taken outside at least 4 times daily. Boarding pets are taken out individually, or with family members only.
Please Select
Please Select
I give permission for my pet to play outside off leash
My pet must remain on a leash at all times while outdoors
Please choose off-leash permission
Please Select
Please Select
Do everything deemed medically necessary by the Veterinarian on duty to revive my pet
Do only minimal supportive care until I am reached (CPR)
Do not rescuscitate
In the event of an emergency while your pet is in our care, how would you like for us to proceed?
23
Add another pet
YESNO
24
Fourth pet name
25
Please confirm boarding dates* This field is required.(Note: We do not offer Sunday drop-off or pick-up times)
26
Please Select
Please Select
Bath (nail trim included)
Nail Trim only
Anal Gland Expression
Exam
Select any additional services you would like performed while your pet is boarding
Please Select
Please Select
Food from home
Dry food provided by the hospital (Royal Canin Veterinary Diet)
Wet food provided by the hospital (Royal Canin GI Lowfat Veterinary Diet)
What will your pet be eating while they stay with us?
Please Select
Please Select
Free feed (leave food readily available throughout the day/night)
Once daily AM or PM
Twice daily (AM and PM)
How often will your pet need to be fed while boarding?
List any food allergies
27
If these services were not previously scheduled, add-on baths and nail trims will be based on availability at time of drop-off.
28
Will your pet require any medications to be given while boarding? If so, please list below. *All medications will need to be brought to the hospital in the original prescription bottle with clear, legible instructions. Please be sure to provide enough medication to last the duration of their boarding stay.
Name of medication
Dosing Instructions
Name of medication
Dosing Instructions
Any health concerns or special requests that weneed to be aware of?
29
All pets are taken outside at least 4 times daily. Boarding pets are taken out individually, or with family members only.
Please Select
Please Select
I give permission for my pet to play outside off leash
My pet must remain on a leash at all times while outdoors
Please choose off-leash permission
Please Select
Please Select
Do everything deemed medically necessary by the Veterinarian on duty to revive my pet
Do only minimal supportive care until I am reached (CPR)
Do not rescuscitate
In the event of an emergency while your pet is in our care, how would you like for us to proceed?
30
Add another pet
YESNO
31
By signing below, I am authorizing the staff of TotalBond Veterinary Hospital to care for my pet while he/she boards in their facility. I accept financial responsibility and understand that payment in full is due upon release of my pet from the hospital. I am acknowledging that my pet is up to date on required vaccines and have received negative results on a current fecal test. If fleas and/or ticks are observed while boarding, preventatives will be administered, and a charge will be assessed. I am also acknowledging that any belongings that are lost or damaged while my pet boards is not the responsibility of TotalBond Veterinary Hospitals.
32
Signature(NOTE - we are going to be printing this information out after the clients fills it out online. We would rather they be able to sign the form at the time of drop off instead of online.)
Clear
33
Date
Date
Year
Month
Day
Should be Empty: