Boarding Form Are you a new client?(Required) Yes No Please complete our New Client Form before your appointment.Owner's Name(Required) First Last Phone(Required)Email(Required) Spouse/Co-Owner's Name First Last PhoneCheck-In Date(Required) MM slash DD slash YYYY Check-Out Date(Required) MM slash DD slash YYYY In the event of an emergency and I cannot be reached please contact the emergency contact below to make a medical decision for my pet(s).Emergency Contact Name(Required) First Last Emergency Contact Phone(Required)Pet's Name(Required) Is this a new pet?(Required) Yes No HiddenPet InfoSpecies(Required) Dog Cat Breed(Required) Color(Required) Age/Date of Birth(Required) Sex(Required) Male Male (neutered) Female Female (spayed) Is your pet microchipped?(Required) Yes No Name of Previous Clinic Previous Clinic PhoneMay we request medical records? Yes No Any previous illnesses or surgeries?(Required) Yes No If yes, please explain(Required)Is your pet on any special diets or medications?(Required) Yes No If yes, please list the medication name and dosage and/or special diet(Required)HiddenSection BreakWill you be boarding multiple pets?(Required)*If multiple pets are boarding, please fill out another boarding form regarding the second or other multiple pets that will be boarding with us. Yes No HiddenAdditional Pet #1Pet's Name(Required) Is this a new pet?(Required) Yes No HiddenSection BreakSpecies(Required) Dog Cat Breed(Required) Color(Required) Age/Date of Birth(Required) Sex(Required) Male Male (neutered) Female Female (spayed) Is your pet microchipped?(Required) Yes No Will you be boarding your pets:(Required) Together Separate Do they need to be separated while eating?(Required) Yes No Add another pet?(Required) Yes No HiddenAdditional Pet #2Pet's Name(Required) Is this a new pet?(Required) Yes No HiddenSection BreakSpecies(Required) Dog Cat Breed(Required) Color(Required) Age/Date of Birth(Required) Sex(Required) Male Male (neutered) Female Female (spayed) Is your pet microchipped?(Required) Yes No HiddenSection BreakWill you be boarding your pets:(Required) Together Separate Do they need to be separated while eating?(Required) Yes No VaccinesFor the safety of all our patients, Blue Diamond Animal Hospital requires all boarders to have proof of current vaccinations. We reserve the right to turn away any border that is past due for vaccines.(Required) I certify that my pet(s) are current on all required vaccinations for boarding My pet(s) need vaccines and I will cover the cost for the vaccines Please select the vaccines your dog needs:(Required) DHA2P Parvo Bordetella Corona Biv Influenza Rabies Fecal Please select the vaccines your cat needs:(Required) FVRCP FeLV Rabies Fecal Has your pet ever had any vaccine reactions (vomiting, diarrhea, facial swelling, hives, etc.)?(Required) Yes No If yes, please describe(Required)Health HistoryDoes your pet suffer from any of the following conditions (please select all that apply):(Required) Heart disease Respiratory disease Seizures Allergies Arthritis Diabetes None of the above Are there any other health or behavioral issues (injuries, wounds, illness, etc.)?(Required) Yes No If yes, please specify(Required)Is your pet pregnant or nursing?(Required) Yes No Does your pet have any food allergies?(Required) Yes No If yes, please specify(Required)Please list any special care that your pet may need(Required)Is your pet currently taking any medication?(Required) Yes No HiddenMedicationsPlease list below any medication(s) that your pet requires us to administer while staying with us. We cannot be responsible for injuries, sickness or harm to pets caused by medications prescribed by other veterinarians. We will only dispense medications to pets according to your instructions below. *There is a $5/day fee for medications/day. (ALL MEDICATIONS MUST BE IN THEIR ORIGINALLY DISPENSED BOTTLE.)Medication Name(Required) Instructions(Required)Last dose given (time)(Required) Hours : Minutes AM PM AM/PM Would you like to add an additional medication?(Required) Yes No HiddenMedication #2Medication Name(Required) Instructions(Required)Last dose given (time)(Required) Hours : Minutes AM PM AM/PM Would you like to add an additional medication?(Required) Yes No HiddenMedication #3Medication Name(Required) Instructions(Required)Last dose given (time)(Required) Hours : Minutes AM PM AM/PM HiddenPlease select the additional procedures you'd like your pet to receive during their stay: Nail trim ($15) Nail dremel ($31) Anal glands expression ($15) Ear cleaning ($17) Bath (after 3 nights a courtesy bath is given/please mark if you would like courtesy bath) (call for pricing) Medication administration ($5/day) Other (call for pricing) If other, please specify(Required) Food: We recommend that you bring your own food with your pet to help alleviate the stress of being away from home. If you did not bring your pet's food, we will feed our Premium house diet.(Required) Yes, I brought my pet's food No, I did not bring food All attempts are made to feed your pet on the same schedule that you feed at home. Please let us know what your pet's feeding schedule is.How many cups?(Required) How many times a day?(Required) Last time fed(Required) Food type:(Required) Dry Wet Both Special feeding instructionsPersonal Belongings: Because bedding is difficult to label and we constantly clean cages and wash blankets, we do not recommend bringing your own blankets or bedding. Blue Diamond Animal Hospital does not allow personal belongings, which include bedding, blankets, toys, dishes, collars, leashes, or any other items other than food. If you deem it necessary to leave items for your pet, you must sign below releasing Blue Diamond Animal Hospital for loss, destruction, and medical emergencies that can happen.(Required) I agree that I fully understand the personal belongings waiver, and I will be leaving belongings I agree that I fully understand the personal belongings waiver, and I will not be leaving any belongings If you are leaving belongings: I agree that I understand Blue Diamond Animal Hospital will not be responsible for any of my belongings and any emergency that may happen due to the items that I choose to leave with my pet.(Required) I have read and understand In the event that my pet(s) becomes ill, the owner shall be notified as soon as possible at the address or phone number listed above. However, if BDAH is unable to reach the owner regarding measures to be taken or the emergency contact BDAH has the right to diagnose or treat the pet within BDAH discretion. Any expenses incurred in conjunction with such care are the owner's responsibility and shall be promptly paid by the owner.(Required) Accept Decline I understand that in the event that my pet has a positive fecal, at the owners' expense Blue Diamond Animal Hospital will treat and dispense medication.(Required) I have read and understand General TermsCPR - Your pet may require cardiopulmonary resuscitation (CPR), including cardiac compressions, positive pressure respiration, emergency medications, or other interventions. If I request such emergency procedures, I agree to be held responsible for veterinary services provided to my pet while staff members pursue treatment and try to reach me for further directions. Regardless of my pet’s recovery or survival, I agree to pay CPR fees in addition to other fees already identified by the practice and agreed upon by me. By declining CPR, in the unlikely event my pet becomes unresponsive during their stay, I consent to allow my pet to pass away without intervention.(Required) I authorize CPR I do not authorize CPR The owner shall pay all costs and charges of and for special services listed in this agreement and all veterinary and medical costs that may be incurred during the term of this agreement for the animal pursuant to this agreement. The owner certifies to the correctness of the information given above with respect to the animal and specifically agrees to be bound by the terms and conditions of this agreement. The owner specifically represents that (he/she) is the owner of the animal and that there is not now any lien or other encumbrance against the animal, and that the animal has not been exposed to Rabies prior to admittance to the custody of BDAH. All necessary precautions are taken to prevent injury and the escape of your pet. Blue Diamond Animal Hospital will not be held liable for problems that develop, provided that reasonable care and precautions are followed. In the event of a medical emergency, we will contact all phone numbers provided to seek approval for veterinary treatment. Owner shall be solely responsible for all of the acts of the animal at any time during the term of this agreement, and in no case shall BDAH be liable for the animal's acts and behavior other than for the exercise of gross negligence on the part of the BDAH, its owners, employees or agents in the boarding and keeping of the animal. Owner shall indemnify BDAH from and against any and all damages sustained or suffered by reason of the boarding of the animal for any claims or injuries arising out of the boarding of the animal except where the injury is caused by the gross negligence of BDAH or its owners, employees or agents. The owner agrees that BDAH will not be held responsible for the aggravation of any pre-existing medical conditions. These include but are not limited to heart disease, arthritis, obesity, infections, and any other conditions that might be discovered by examination. If you are unable to pick up a patient at the scheduled pickup time, you must call before 48 hours. Otherwise, there will be a charge of $25 inconvenience fee in addition to the additional night fee.By signing below, I acknowledge that I have read and fully understand the terms of this Boarding Information, Waiver, and Release Form and I accept the terms and conditions contained herein.(Required) I have read and understand Digital Signature(Required) Date(Required) MM slash DD slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.