General Information

Patient Name (required) Pet Owner (required)

Is your pet healthy?
YesNo

Any health concerns?
YesNo

Eating and drinking?
YesNo

Any V/D/C/S?
YesNo

On HWP?
YesNo

HWP Refills needed?
YesNo

On FTP?
YesNo

FTP Refills needed?
YesNo

Is your pet on any other medications (this includes preventatives and supplements)?
YesNo

If yes, please indicate type of medication, duration, and when last medication was given:

Does your pet(s) have any known health conditions?
YesNo

If yes, please indicate type:

Boarding Requirements

For the protection of your pet, and all pets visiting our facility, we require the following be current to board your pet at New Hope Animal Hospital:

Canines Felines
Physical Exam by one of our doctors within the last year Physical Exam by one of our doctors within the last year
Rabies Vaccine Rabies Vaccine
Distemper/Parvo Vaccine (DHPP) Distemper/Upper Respiratory Vaccine (RCCP)
Bordetella Vaccine w/in last 6 months
Negative Intestinal Parasite Screening w/in last 6 months

If your pet(s) is not a patient at our hospital, we require written documentation from a licensed veterinarian that verifies your pet(s) is current on the required vaccinations and testing.

Per manufacturer guidelines, in order for vaccines to be most effective, they must be administered 10 days prior to a boarding stay. If these guidelines are not followed, your pet may not have adequate protection from illnesses that are present in a hospital environment and New Hope Animal Hospital will not be held responsible in the event of a preventable illness.

Boarding Care

Intestinal Parasites
If your pet(s) is found to have intestinal parasites upon arrival to our hospital, de-worming medication will be administered at the appropriate fee.

Flea and Tick Prevention
If your pet(s) is found to have fleas or ticks upon arrival to our hospital, flea and or tick prevention will be administered at the appropriate fee.

Feeding
Changes in your pet's diet can be traumatic to their digestive system. We encourage you to bring your pet's food from home to avoid any problems. If you choose not to bring food, we offer Science Diet dry food free of charge while your pet is boarding. If your pet does not eat well while here, we may also try offering canned food at your expense.

Stress
If your pet experiences stress diarrhea, we will offer a bland prescription food to settle your pet's stomach at no extra charge. If the diarrhea worsens or persists longer than 2 days, your pet will be treated with propectalin tablets at your expense.

Personal Items
The cleaning products used to provide a sanitized environment can damage and fade many fabrics during laundering. We do not recommend bringing personal items that are valuable or irreplaceable. NHAH is not responsible for loss or damage to any personal item or toy left with your pet.

Behavior
We reserve the right to refuse to accept a pet for boarding if it appears that your pet is sick or that it's behavior could jeopardize the health or safety of other pets or our staff.

I have read the above and agree to the outlined treatments.
I agree

Behavior Information

Does your pet have any phobias? (check all that apply)
ThunderLoud NoisesVacuum CleanerOther

If yes or "other", please explain:

Has your pet ever bitten another person or animal?
YesNo

If yes, describe circumstance:

Scheduling

Arrivals and Departures
You may check your pet(s) in or out from boarding at any time during our normal business hours. We respectfully request that you contact us in the event that you are unable to pick up your pet(s) on the scheduled departure date, as this may affect other client's boarding reservations.

Cancellations
NHAH requires that you cancel boarding reservations two days prior to arrival date.

Emergency Care

NHAH will provide life-saving care in the event of an emergency or accident at your expense. Some owners with very ill or debilitated pets may elect not to have their pets resuscitated in the event of an acute, life-threatening illness or injury.

Please select what type of care you would like for your pet - we will make every attempt to contact you as soon as possible:
The staff at NHAH has my permission to provide life-saving emergency care, if it should be required and I agree to pay for all services.I elect NOT to have my pet revived if life-saving emergency care should be needed. Please do NOT resuscitate my pet with CPR or other means.

Pet Health
You acknowledge that your pet has not been exposed to Rabies, Distemper, Kennel Cough, or any other contagious illness within 30 days prior to arrival date of boarding with us.

If your pet becomes ill or injured and requires medical attention, please note your wishes:
I authorize a maximum expenditure as marked below for diagnostic testing and necessary medications, while NHAH team members attempt to contact me.I do not authorize any diagnostic testing or services without prior consultation.

Maximum Expenditure:

Please note: Due to our Veterinarian's oath and our hospital's standard of care, we WILL NOT allow a pet to remain in a medical state that would cause pain and discomfort. If you are not readily available to authorize recommended medical treatments, NHAH will initiate any appropriate treatments to alleviate any pain or discomfort, at your expense, until you can be reached and a treatment plan can be presented to you. If you refuse medical treatment for your pet, NHAH may engage the services of one of our staff veterinarians and/or administer medicine, at your expense, to make your pet as comfortable as possible until picked up by you or the named guardian/agent.

Payment for Services

You agree to pay NHAH for the services we provide to your pet during each visit. Prices are subject to change without notice. Charges begin on the arrival date and are charged per day of boarding.

I have read the terms of this agreement and will make complete payment to New Hope Animal Hospital at the time of discharge.

Please sign your name below (required)

Date (required)

Emergency Contact Number Name Relationship