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-I will not hold Thunderbird Veterinary Hospital (TVH) responsible for conditions that are unavoidable in boarding kennels including but not limited to: weight loss or gain, hair loss, upper respiratory infection, bronchitis, diarrhea, intestinal parasites, and flea/tick infestation.
_______ (initial)
-I understand all pets admitted to TVH must be free of internal and external parasites. If not, the animal will be treated on discovery at the owner / agent’s expense. If vaccinations were performed elsewhere, I will provide written documentation of rabies vaccination administered by a licensed veterinarian._______ (initial)
-I understand that not all “kennel cough” infections are preventable, even with routine vaccinations. I will not hold TVH liable in the event that my animal contracts “kennel cough” before, during or after visiting our boarding facility._______ (initial)
-I understand that in the event of any sudden or new illness, TVH will immediately attempt to contact me or my agent to discuss the problem and treatment options. If the emergency contact listed below is not available, the clinic is authorized to initiate appropriate treatment until myself or my agent can be reached. _______ (initial)
-In case of fireworks &/or thunderstorms, I authorize the medical staff to administer sedative medication to my animal. YES_______ (initial) NO_______ (initial)
-I understand that TVH is not responsible for loss or damage to personal items left with my animal including but not limited to leashes, collars, harnesses, toys, and bedding. ______(initial) -I agree to pay, in full, all charges for necessary services rendered to my animal. TVH is to use all reasonable precautions against injury, escape, or death of my animal. TVH and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed._______ (initial)

Should an emergency arise, I authorize the medical staff to sedate, medicate, hospitalize and/or perform such emergency procedures as may be necessary for the health of my animal until I or my agent can be notified.
YES, treat my animal in an emergency_______ (initial)

NO, do not treat my animal in an emergency, aka DNR_______ (initial)
Date: ________________ Owner / Agent: __________________________________________

Emergency contact that is able to be reached during boarding stay:
Name (print):________________________________________Phone:____________________

Admitting Technician Initials: _______

Client Name:_________________________________________________________________

Address:_____________________________________________________________________ City, State:_____________________________________________Zip:___________________ Patient:________________________________________________Sex: M / F Neutered: Y / N Species: ___________ Breed:____________________ Color: __________________________ Is your pet on heartworm prevention? Y / N If so, what type?___________________________ Is your pet on flea/tick prevention? Y / N If so, what type?_____________________________ Any vomiting, coughing, sneezing, diarrhea in the last 48 hours? Y / N If so, please describe: ____________________________________________________________________________ Has your pet had any illness or injury in the past 30 days? Y / N If so, please describe: ____________________________________________________________________________ Food Type: kennel / own food Feeding Amount:____________ Frequency:____________

Current Medication                   Next Dose Due                  Frequency of Administration


Do you have any concerns for the veterinarian? Y / N (Note: exam fee of $49.00 will be assessed for a DVM exam)______________________________________________________

____________________________________________________________________________ Pick up date:______________ Time:_____________ Bath before pickup? Y / N (additional fee) Client Signature:___________________________________________Date:_______________


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