Your name *

First Name

Last Name

Phone *

(###)

###

####

Drop-off date *

MM

DD

YYYY

Pick-up date *

MM

DD

YYYY

Has your pet been experiencing any respiratory symptoms, such as coughing? *

No, my pet(s) have not been coughing or exhibiting signs of respiratory symptoms.

Yes, my pet has been coughing or showing signs of respiratory illness

Consent to fecal screen *

To protect our boarding pets from gastrointestinal parasites, we require that all dogs in our boarding kennel be up-to-date on their annual fecal ova test. Cost of fecal screen: $25.00

My pet has had a negative fecal exam at Laytonsville Veterinary Practice within the last 12 months. If my pet is found to be overdue, I consent to an updated fecal test to be performed at the start of my pet's stay.

My pet has had a negative fecal exam performed within the last 12 months at another facility, and I will be providing the results of this test prior to or during drop-off.

My pet is overdue for a fecal exam, and I consent to an updated test being performed at the start of my pet's stay.

Not applicable - I am boarding cats only.

Would you like your pet(s) to receive a bath or nail trim during their stay? *

Bath and nail trim

Nail trim only

I do NOT request a bath or nail trim during my pets' stay

Does your pet have a procedure scheduled during their stay? *

To best prepare your pet(s) for their upcoming procedures (i.e. fasting, recovery care, etc.)

No, my pet does not have a procedure during their stay.

Yes, my pet does have a procedure during their stay.

Boarding consent agreement *

Please read the following carefully before submitting this form: In the event that I am not reachable, I authorize Laytonsville Veterinary Practice to treat, medically and surgically, any emergency situation that may arise with my pet(s), and I will be responsible for any fees incurred. If a non-emergency health concern is identified by a technician during boarding (example: ear infection), I agree to allow one of the doctors at Laytonsville Veterinary Practice to examine and treat the condition, and I will be responsible for any examination and medication fees incurred. I understand the set times for drop-offs and pick-ups. I understand that there will be no pick-ups or drop-offs on major holidays. I will call if my plans change and I need to pick up my pet(s) sooner or later than I originally indicated. Notice: Additional charges will be applied to drop-offs or pick-ups outside of the designated times. I understand that veterinary care during nighttime hours and /or weekends is provided at the discretion of the attending veterinarian. Continuous presence of personnel may not be provided during these hours. -

I understand and agree to the above boarding protocol, and authorize Laytonsville Veterinary Practice to make medical decisions concerning my pet on my behalf should I not be able to be reached. I understand that additional fees may be incurred by any necessary medical treatment that may be done on my pets' behalf, as well as by pick-up or drop-off outside of the designated times.