Boarding Consent Form

Client/Patient Info

Owner's Name (*)

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Email (*)

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Date In (*)

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Date Out (*)

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Pick Up Time (*)

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Pet's Name (*)

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Client ID

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*All animals boarded at Centennial Hills Animal Hospital are required to have a negative intestinal parasite screening within the last (6) months as well as proof of being current on the following minimal vaccinations*: Dogs: Distemper, Parvovirus, Bordetella, Rabies, Canine Influenza Cats: Ent-Fvrc, Rabies

Boarding Info

Small Kennel (Up to 25lbs*)

Invalid Input*May hold up to 2 pets equalling less than 25lbs
Large Kennel (Up to 50lbs*)

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Run 51-200lbs

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Feeding - We feed Hill's Science Diet Sensitive Stomach with Chicken (Complimentary) If you would like to add canned food to your pet's meals, it is $3.74/can

Other Info

Special Instructions, Medications, Special Diets (Special diets must be provided by the owner)

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Additional services are available for your pet while boarding (Please check all that apply)

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Emergency Contact Name & Number (*)

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PAYMENT IS DUE IN FULL AT THE TIME OF SERVICE I am the owner or authorized agent of the pet(s) mentioned and accepts full responsibility for all costs incurred. I understand that as a condition of treatment by this hospital, any financial arrangements must be made in advance. In the event that this account should go unpaid, I will be subject to the cost of collections, including attorney fees and/or collection agency fees, which may include charges of up to 50% of my unpaid balance. There is a 15% finance charge applied to all balances over 30 days, and a $7.50 billing charge on all balances which is applied at the end of each month. Certain procedures and services may require a deposit (cash or credit card only), with the remaining balance paid in full at the time of release. For your convenience, we also accept the following forms of payment: CASH, VISA, MASTERCARD, DISCOVER
By pressing the submit button, I grant permission for any necessary veterinary emergency treatment and care during my pets boarding stay and realize that I am responsible for cost.

“We have been happy with every service received here, from routine rabies shots to emergency surgery.”