Medical Boarding Agreement

Client Information

Address

Patient Information

Is your pet spayed/neutered?
MM slash DD slash YYYY

I, the undersigned, am the authorized agent or owner responsible for seeking care for the pet identified above, and certify that I am 18 years of age or older.

I understand the daily fee for Medical Boarding is $150.00 per day. There may be additional charges for medications administered. I understand that I will recieve an estimate for care prior to admitting my pet for medical boarding. I understand that I will be required to leave a 50% deposit on admittance of my pet and that payment in full is due at time of discharge. Veterinary Specialists of the Rockies(VSR) takes all possible care in the treatment and handling of animals, but cannot assume responsibility in the case of fire, theft or escape.

Veterinary Specialists of the Rockies requires my pet to be up to date on vaccines for: Rabies and FVRCP. I understand that vaccine documentation is required before admittance. If my pet is unable to receive vaccines, medical documentation is required from a licensed veterinarian. If external parasites are found on my pet during boarding, I authorize treatment for this and accept financial responsibility. FIV/FelV test results are also required prior to boarding.

In the event of a natural disaster or emergency, every effort will be made to contact you or your agent. I understand that Veterinary Specialists of the Rockies will make every effort to transport or make temporary arrangements for pet until myself/my agent can retrieve my pet. Additional costs may apply.

I also agree to inform VSR of any possible upper respiratory symptoms my pet has been having within 2 weeks boarding, and if so, agree pay to an additional $50.00/day for isolation boarding. I am aware if my pet begins showing signs of an upper respiratory infection including but not limited to sneezing, coughing and eye or nasal discharge while in the care of VSR, my pet will be moved to the Isolation ward and I accept all additional fees.

In the event my pet becomes ill while in the care of Veterinary Specialists of the Rockies, I understand the attending veterinarian will attempt to reach me regarding the health and treatment of my pet. I authorize the staff of Veterinary Specialists of the Rockies to initiate treatment at the discretion of the veterinarian before speaking to me if I cannot be reached and I agree to pay for all related fees.

Veterinary Specialists of the Rockies requires that I provide contact information for an agent, over the age of 18 years in the event that I cannot be reached in an emergency. This contact will not be travelling with me and is authorized to make decisions regarding placement and/or treatment of my pet including CPR directives if necessary.

In the event of a pet passing away in the care of Veterinary Specialists of the Rockies, he/she will be held until the pet can be picked up or VSR can arrange for cremation for an additional fee.

I acknowledge that I may bring personal items for my pet during their stay (beds/toys/blankets), but Veterinary Specialists of the Rockies is not responsible for items if they are lost, stolen, damaged or ingested. I acknowledge that VSR is not responsible for any complications associated with possible ingestion of foreign objects.

Veterinary Specialists of the Rockies asks that you bring your pet's food and feeding schedule for their stay. If enough food is not provided, I am aware I will be charged for feedings, up to $10.00 per feeding.

Veterinary Specialists of the Rockies requires all medications are to be brought in there original containers to confirm appropriate dosing and administration. Medications are required to be current and valid. I agree to pay for any medications that need to be refilled during my pet's stay.

Patient Medical Information

Feeding Instructions

Agent Information

Cardiopulmonary Resuscitation (CPR) Directive

I understand Veterinary Specialists of the Rockies (VSR) requires a CPR status prior to the start of any and all procedures so immediate action can take place in the event of cardiopulmonary arrest during, before, or after anesthesia or anytime in our care. I acknowledge that the attending veterinarian or staff members of VSR will make every effort to contact me regarding treatment in the case of this unforeseen event. The starting cost of CPR is approximately $400.

I am the owner / agent of this pet and ...
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