Henrietta Animal Hospital, PLLC
Boarding Admission Agreement

1.      In case of illness or injury, I the undersigned do hereby grant consent for the       veterinarians at the Henrietta Animal Hospital to treat, prescribe for or perform emergency surgery upon my pet(s) while they are boarding.
2.      I, the undersigned agree to assume full financial responsibility for the above should such a situation arise.
3.      The hospital staff is to use all reasonable precautions against illness, injury or escape of my pet(s) but will not be held liable or responsible in any manner whatsoever, under any circumstances on the account of the care, treatment, or safekeeping of my pet(s).  It is thoroughly understood that I assume all risks.
4.      I understand that all attempts will be made to contact me, if other than minor procedures need to be performed.  Fecal exams, symptomatic treatment for vomiting, diarrhea, or skin problems are examples of minor treatment.
5.      I understand that my pet(s) will be checked for fleas upon admission and discharge.  They will be treated accordingly if fleas are found.
6.      Please answer the following questions in concerns for your pet’s health:
Fleas ____ Sneezing ____ Coughing ____ Vomiting____ Scratching ____ Diarrhea ____ Other____ Special Diet ____ Requires Medication ____ Have there been any unusual signs or symptoms that we should be aware of while boarding your pet(s)? ___________________________________________
7.      Upon admission I accept the fact that all my pet(s) must be current on vaccinations.  Dogs require all routine vaccinations, kennel cough, and Heartworm testing.
8.      I understand that if I have no confirmation of vaccinations, that the veterinarian will vaccinate my pet and I will be required to assume financial responsibility.
9.      If my pet is found to be aggressive and dangerous to the staff or other animals, all additional charges will be added to the total bill.
10.  All pets that are not picked up within 7 days after the expected date of pick up will be considered abandoned.  The ownership on the 8^th day will be that of the Henrietta Animal Hospital’s and such owner will do with the pet, as they deem best, including adoption and euthanasia.  The owner will still ultimately be financially responsible for the boarding bill up to the 8^th day.

I have read, understand, and agree.
Signature: _____________________________Print Name __________________
Address _________________________City, State, Zip_____________________
Emergency phone number where I can be reached ________-______-_______
Neighbor, relative, other/alternate contact information _______-______-________

How do you intend to pay for your pet’s boarding and other fees?

MC/Visa ____ Discover ____ Cash ____ Check ____ (2 forms of ID required)
Starter checks are not accepted.  (Note: To pay by check, we MUST have a social security number and NYS DL# on file).
Please direct any and all suggestions, comments, complaints and other feedback to the doctor.     Thank you.