Boarding Admission Form in Pasadena, CA - Petsadena Animal Hospital

Name*

First Last

Pet's Name*

Date of Check-Out

Time of Check-Out

: HH

MM

(Note: If You Are Unable To Pick Up Your Pet Before 1pm On Your Check-Out Date, You Will Incur A Fee Of $20 For The Additional Care Of Your Pet)

What kind of diet does your pet receive at home?

Will your pet(s) require their own diet?

Yes
No

Amount per serving

cup(s)

How Often

Is your pet on any flea preventative?

Yes
No

If yes, please specify when last administered

Petsadena Animal Hospital (PAH) is not responsible for any personal belongings left with your pet unless stated otherwise in writing by PAH.

Will your pet(s) require medication administration?

Yes
No

Medication Regimen: Medication fees: [#1-3] medications ($7 per day) and [#4+] medications ($13 per day)

To eliminate any flea infestations, if fleas are seen on your pet, we will be administering Capstar, a safe, rapid, effective flea treatment, a $5 fee will be added to your invoice.*

I acknowledge the above statement

I would like for my pet to receive:

Nail Trim $19.50
Ear Cleaning $34.26-$60.13
Examination $57.00
Bath (includes nail trim, light ear cleaning, and anal gland expression) *ask for prices*

1. All pets admitted for boarding must be current on exam (performed at PAH) and vaccines. Written proof of vaccinations or verification with the pet’s veterinarian must be provided before boarding the pet(s). I consent that if vaccinations are overdue they will be administered and the cost will be added to the total bill.
2. All pets admitted for boarding will be checked for external parasites (fleas/ticks). If internal or external parasites are found on the pet during the stay, I consent to treatments as you determine, and the cost(s) of the treatment(s) will be added to the bill.
3. The clinic and team will not be held liable for any unforeseeable circumstances that may result in injury or death of the pet(s) while boarding.
4. All pets not picked up within 7 days after the contracted date of pickup will be considered abandoned unless other written arrangements are made with PAH on or before the 7th day. Otherwise PAH will arrange for the pet’s well-being and will so notify owner or responsible party in writing. Owner or responsible party hereby releases PAH from any liability as a consequence of pet abandonment. Owner or responsible party is obligated to PAH for any expenses incurred by PAH as a consequence of pet abandonment.

Authorization of Treatment

I authorize Petsadena Animal Hospital to treat any unexpected non life-threatening medical problems such as diarrhea, lameness, skin infections and ear infections.*

Yes
No

Up to a maximum of $*

In the event of a life threatening emergency, I authorize Petsadena Animal Hospital to treat my pet, and then contact me at the emergency number listed above.

Yes
No

Up to a maximum of $*

I understand that if neither my emergency contact nor I are reachable, or if my emergency contact does not give permission to treat until I am reached, at my expense, PAH will take the necessary steps to stabilize my pet and alleviate pain/ discomfort until I am contacted.*

I acknowledge the above statement

The above conditions have been explained to me and I fully understand this agreement including that I am responsible for all costs incurred for any exams, diagnostics and treatments provided.*

I acknowledge the above statement

Signature*

(Your digital signature (full name) is as legally binding as a physical signature.)

Date