65 Finlay Road, Orleans, MA, 02653

508.255.1194

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CLIENT CENTER

SHOP ONLINE

508.255.1194
65 Finlay Road
Orleans, MA, 02653

Home
About
Services
Resources
Contact

CLIENT CENTER

SHOP ONLINE

Boarding Admission Form

Contact Information

Client Name(Required)

First Last

Phone(Required)

Phone number where YOU can be reached while you're away.

Can this number receive text messages?(Required)

Yes

Email(Required)

Residential Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address(Required)

Same as previous

Street Address Address Line 2 City State ZIP Code

Emergency Contact Name(Required)

Person who can make medical decisions for you if you are NOT available)

First Last

Emergency Contact Phone(Required)

Is any other person authorized to pick up your pet(s)?

Pet #1 Information

Pet's Name(Required)

Species (Dog/Cat/Other)(Required)

Breed(Required)

Color(Required)

Birth Date (Age)(Required)

Sex(Required)

Female

Male

Is your Pet...

Spayed

Neutered

Is your Pet Micro-chipped?(Required)

Yes

# if yes(Required)

Is your pet on monthly flea and tick control?(Required)

(please note that if your pet has fleas/ticks upon check-in, preventative will be applied to your pet at your expense.)

Yes

Which one?(Required)

Date of last application(Required)

List any known allergies:

Please list any pre-existing physical or medical problems with your pet.

Add a 2nd Pet?(Required)

Yes

Pet #2 Information

Pet's Name(Required)

Species (Dog/Cat/Other)(Required)

Breed(Required)

Color(Required)

Birth Date (Age)(Required)

Sex(Required)

Female

Male

Is your Pet...(Required)

Spayed

Neutered

Is your Pet Micro-chipped?(Required)

Yes

# if yes(Required)

Is your pet on monthly flea and tick control?(Required)

(please note that if your pet has fleas/ticks upon check-in, preventative will be applied to your pet at your expense.)

Yes

Which one?(Required)

Date of last application(Required)

List any known allergies:

Please list any pre-existing physical or medical problems with your pet.

Policies

Photo Release

Please check here if you do NOT want your pet’s image used.

Occasionally we take pictures of our patients for use on our website or Facebook page.

Vaccines: All pets must have current vaccines for rabies, distemper, bordetella and canine influenza. If your pet does not receive his/her vaccines at this facility, you must show documentation that verifies current vaccinations. If any vaccinations are past due, your pet must be vaccinated prior to boarding for his/her protection. Any pet not current at time of drop off will not be allowed to board and will have to make alternate arrangements.

Fecal Test: All pets must have a fecal with giardia test with a negative result within 6 months of boarding/daycare. If your pet is not a client at The Animal Hospital of Orleans you will be required to provide documentation verifying a negative fecal with giardia test.

Diet: At the Animal Hospital of Orleans, we supply Hill's Science Diet Maintenance dry kibble only. We do not supply prescription diets. We recommend all pets come in with their own food to help keep digestion regular. We do not accept raw diets of any kind. (All canned food and prescription diets must be supplied from home)

Boarding Policy(Required)

I acknowledge that I have read and understand the boarding requirements and the Animal Hospital of Orleans policies listed below.

A. I am aware that all animals entering the Animal Hospital of Orleans Boarding Kennel must be current on all required vaccines and be free from internal and external parasites. If these conditions are found to not be met, the appropriate services will be provided Monday through Friday, during regular business hours and I will be charged accordingly. Charges will include a $75.00 unscheduled fit in fee.
B. I am aware that my pet(s) will be released only during regular office hours and payment in full is required at that time.
C. A 50% deposit is required for any boarding over two weeks.
D. If my pet is experiencing Fear, Anxiety or Stress during his/her stay it may be necessary for The Animal Hospital of Orleans to do an exam and prescribe and administer the appropriate medications to relieve his/her Fear/Anxiety/Stress for the duration of the stay.
*Non-client patients will be asked to first contact their primary veterinarian to see if a prescription can be sent to a local pharmacy. If this is unable to be accomplished, then the pet would receive a complete physical exam by an AHO veterinarian before medications are prescribed and will be charged accordingly.
**Weekend and holiday hours emergency fees will apply and may not always be available.
***If Fear, Stress or Anxiety is at an extreme state wherein the dog is at risk it may be necessary for the owner or emergency contact person to pick up the pet.
****There will be a daily administration and monitoring fee of $16.75 if medications need to be given.
E. I have been informed that the Animal Hospital of Orleans is not staffed 24 hours a day. Staff is present 8am – 5pm 7 days a week.
F. The Animal Hospital of Orleans is not responsible for items accompanying my pet that are misplaced, lost or destroyed while boarding. All items brought in from home must fit easily into a standard size washing machine so we can maintain a clean and healthy environment for our boarders.
G. The Animal Hospital of Orleans is not responsible for any illness or accidental injury to my pet while boarding such as, but not limited to, digestive upset, cuts, sprains, etc...
H. I am aware that though all pets are current on vaccinations in order to board that a vaccine does not always equal 100% protection. I am aware that there is a risk of exposure to kennel cough and/or canine influenza by having my pet in a kennel and I am responsible for the cost of treatment if needed.
I. I am aware that if my pet comes in with any sort of medication, supplement or vitamin I will be charged a daily fee of $16.75 for the administering of these medications. All medications are required to come in their original bottles with a clearly printed label. Vitamins and supplements are considered a medication, should also come in the original bottles and are subject to the medication administration fee.
J. If I neglect to pick up my pet and do not notify the kennel within 5 days from the scheduled pick up date, The Animal Hospital of Orleans may assume the pet is abandoned and is authorized to start the process of transfer of ownership of the pet as they deem necessary according to Massachusetts State Law.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

Safety(Required)

I acknowledge that my pet has not bitten anyone within the last 10 days.

Consent for Medical Services

One of the advantages of boarding your pet at a veterinary hospital is that veterinary attention is readily available should the need arise (Monday through Friday during regular business hours). In the event that a medical evaluation is necessary during boarding, the Animal Hospital of Orleans will make every effort to contact you or your designated emergency contact. In the event that you or your emergency contact cannot be reached, it would be helpful to know how you would like us to proceed in caring for your pet. Please indicate your wishes below should your pet require treatment or diagnostics for a medical condition.

PLEASE CHOOSE ONE OF THE FOLLOWING OPTIONS:(Required)

It is NOT necessary to contact me first, please have my pet seen by one of the AHO veterinarians. Proceed with all recommended medical care.

Try to contact me and/or my emergency contact. In the event that neither of us is reachable, do whatever treatment is reasonable to keep my pet stable until you are able to reach me or my emergency contact.

If tests, treatments, evaluations, or observations are needed that extend beyond what AHO veterinarians and staff are able to provide, recommendation for further medical attention at a 24 hour veterinary facility will be given. Owner is responsible for any expenses incurred due to consult, exam, diagnostics, medication, or other medical procedures performed at the Animal Hospital of Orleans or another facility.

OPTIONAL, At the discretion of the veterinarian in charge of my pet’s care, if my pet is suffering and/or has lost all quality of life, I hereby authorize and request humane euthanasia for my pet.

Hold remains until I return

Private cremation, have ashes returned to me

Group cremation

Consent for Medical Services(Required)

I authorize my emergency contact to transport my pet to a 24 hour veterinary facility at the discretion and recommendations of the veterinarians at AHO. If my emergency contact is not available, I authorize the staff AHO to perform the transport.

Consent for Medical Services(Required)

I agree to be responsible for all costs and charges associated with treatment at AHO and those incurred with care outside of AHO.

Signature(Required)

By signing below, I acknowledge that I have read and understand the consent for medical services.

Date(Required)

MM slash DD slash YYYY

Phone

This field is for validation purposes and should be left unchanged.

ANIMAL HOSPITAL OF ORLEANS

65 Finlay Road
Orleans, MA 02653

508.255.1194

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