I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age. 

CONTACT INFORMATION

BOARDING INFORMATION

Weekend pickup/drop-off times are 9:00-10:00am and 4:00-5:00pm

Weekend pickup/drop off fee is $30 (if dropping off and picking up on a weekend, it is 2 separate fee's) on normal days of the year. (Holidays differ in price.)

Medication: We will administer any required medications to your pet(s) for an additional charge. Only medication prescribed by a licensed veterinarian and appropriately labeled will be given. If medications need to be filled or refilled, the charges will be added to your bill. Pets requiring extensive medical monitoring or treatment are considered hospitalized and will be charged for hospitalization and not boarding. 

Vaccines: In order to board your pet(s), vaccines must have been given per clinic standards. If your pet does not receive it's vaccines at this facility, you must show documentation from another licensed veterinarian that verifies current vaccinations. If any vaccinations are past due, your pet(s) must be vaccinated before boarding for his/her protection, as well as the protection of other animals. If we do not receive your pet(s) vaccine records, vaccines will be administered at this facility and added to your bill as well as a Physical Exam fee if your pet has never been seen by our facility.

Parasites: All pets must be free from external (e.g. fleas, ticks) and internal parasites (e.g. hookworms, roundworms). They are required to have an up to date fecal examination done within 6 months of boarding. At our discretion, if internal or external parasites are found, the cost of treatment will be added to your bill. 

Any animal found to have internal or external parasites while Boarding will be treated at owner's expense. 

Medical Treatment: Reasonable precautions will be taken against injury, escape, or death of your pet. If your pet develops any medical condition during their stay we reserve the right to treat as necessary to prevent the spread of illnesses. In the event that your pet experiences a life threatening problem, we will make every attempt to contact you or any authorized agent listed on this form. If we are unable to contact you we will proceed as the doctor deems necessary. If you do not want us to perform life saving procedures for your pet, please sign the DNR (Do Not Resuscitate) order below. I understand that all treatments will be my financial responsibility. Our clinic cannot guarantee the health of any animal, but pledges to give appropriate care to all boarded pets. I hold the clinic harmless for conditions that often are unavoidable in boarding environments such as, but not limited to: weight loss, rough hair coat, kennel cough, upper respiratory infection, and diarrhea. Note: Some medical problems may not be evident in a kennel environment. 

In the event that your pet should experience cardiac or respiratory arrest while being hospitalized today, do you give consent for resuscitative efforts to be initiated until you can be contacted further and notified of your pets status? 

By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor's discretion. Please initial your choice below: 

Agreements

I agree to make full complete payment to the hospital at the time of discharge. Note: A deposit may be required on admission at the discretion of the hospital.

Notice- Southern Haven Veterinary Clinic does not have staff on site from 5:30pm-7:15am. Southern Haven is equipped with a fully functioning fire alarm system, but does not have a fire protection sprinkler system.

I understand that if I fail to pick up my pet(s) within 12 days of schedule pickup, my pet(s) will be considered to be "abandoned", and will be handled in accordance with state law, and that doing so does not relieve me of my financial obligations.

Check each item to agree to the terms: