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Appointment Request
Home
About Us ▼
About Us
Standards of Care
Meet Our Team
>
Our Veterinarians
Our Care Team
Meet our Staff Pets
Holiday Hours
Reviews
Take a Tour
Dog Park
Community Support
Services ▼
Boarding
New Pet
>
New Kitten
New Puppy
Small Animal Services
Production Animal Services
Online Store
Resources ▼
Online Forms
>
New Client Form
New Pet Form
Surgical Consent Form
Boarding Consent Form
Drop-Off Consent Form
Emergency
Financial Assistance Organizations
Parasites
>
Fleas
Heartworms
Ticks
Surgical FAQS
Discharge Instructions
Drugs / Diseases / Surgical Procedures
Helpful Links
Pet Insurance
Pet Records
Seasonal Pet Care
Contact Us ▼
Appointment Request
Boarding Consent Form - Per Pet
** For the safety of all our boarding pets, ALL required vaccinations must be current
PRIOR
to boarding admission. Overdue vaccinations will need to be updated at least 3 weeks prior to boarding with us. If your pet has never been to our facility, please email a copy of the vaccination history to
rowananimalreception@gmail.com
when you submit this form if you have not already done so.
Pets with overdue vaccinations will not be admitted to boarding. Patient safety is our number one priority and we appreciate your understanding in this matter.
Also, due to the increasing reports of
Canine Influenza
in the surrounding areas, as recently as Oct 2018 in Charlotte, NC, we will be updating our boarding vaccination requirements for dogs to include the Bivalent Influenza vaccine. Please take a moment to review the information about this virus and vaccine by clicking the link above or on our home page. If you have any questions concerning this, please do not hesitate to call us! **
Client Information
*
Indicates required field
Client Name
*
First
Last
If you are an existing client, please list the name on your account at the clinic.
Client Type
*
NEW Client and NEW Pet (fill out ALL information)
EXISTING Client and EEXISTING Pet (fill out required information)
EXISTING Client and NEW Pet (fill out ALL information)
Home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
If you are an existing client, please list the phone number on your account.
Phone Type
*
Home
Cell Phone
Email (requested)
*
P
et Information
Pet Name (list one)
*
D.O.B. or Approximate Age
*
Sex
*
----
Female
Spayed Female
Male
Neutered Male
Pet Breed
*
Color/Markings
*
Reservation Information
All boarding charges are per night. Charges are incurred each evening after closing hours.
CONFIRMED Reservation Dates - If you have not already reserved dates for boarding, please contact our office or fill out a boarding reservation request form.
*
Approximate Drop-off and Pick-up times
*
Housing
*
Boarding Alone
Sharing
If sharing, please list additional pet(s) name(s)
*
Behavior
Pets that are boarding together may be separated if they show cage aggression, food aggression or any other unforeseen behavioral change. This is to ensure the safety of your pet and our staff during their stay.
Please read and fill out completely.
If we need to contact you during your trip what number(s) should we call to reach you?
Emergency Contact Name (Primary)
*
Emergency Contact Phone Number (Primary)
*
Emergency Contact Name (Secondary)
*
Emergency Contact Phone Number (Secondary)
*
Walking
All pets are walked two to three times a day. They are returned to cleaned kennel with fresh water and food if it is feeding time.
Feeding
Feeding (choose one)
*
NO, I did NOT bring food for my pet. Please offer Science Diet Sensitive Skin and Stomach dry food as provided by Rowan Animal Clinic.
YES, I have brought my pets food from home and it is labeled with my pet's name. Please use the following feeding instructions for my pet.
Feeding Frequency (choose one)
*
Once a day in the morning
Once a day in the evening
Twice a day
Please list the amount of food normally offered at each feeding.
If you brought food from home, please list the brand of the food.
If indicated, please list instructions regarding any treats brought from home.
Feeding Amounts and Instructions
*
*Please Note*
For pets receiving our clinic diet:
If canned food is requested, we feed i/d prescription canned food which is offered at additional cost (price/can).
Personal Items
*Please Note*
For safety reasons, we do not leave collars or harnesses on your pet while in our facility. If your pet must be walked with a harness due to medical reasons, please be sure to indicate this below.
Description of Items (if applicable)
*
Bedding or toy(s) may be removed if your pet decides to destroy the item. They may also be removed temporarily if they need to be cleaned.
Medication
Does your pet need any medications administered while boarding?
*
No, my pet does not need any medications administered while boarding.
Yes, my pet does need medication administered while boarding. (Please list medications and instructions in the appropriate box.)
Medication Instructions (if applicable)
*
Bathing
*
YES, I would like to have my pet bathed the morning of pick-up. I understand that my pet may not be dry until the afternoon.
NO, I would not like to have my pet bathed the morning of pick-up.
Vaccination
Current vaccinations given by a licensed Veterinarian are essential for the protection of all animals in our care.
Pets with overdue vaccinations will not be admitted to boarding.
Upcoming vaccinations and preventive care exams can still be updated while boarding with us for your convenience.
It is our policy that all dogs MUST be current on DHLP, Bordetella, and Rabies vaccinations in order to board with us.
All canine boarders will be given this vaccination upon entry to boarding starting November 1st 2018. A booster vaccination must be given in 2 weeks.
A completed Bivalent Influenza vaccination series and 2 weeks waiting period (total of 4 weeks) will be a required for boarding starting January 1st 2019.
It is our policy that all cats MUST be current on FVRCP and Rabies vaccinations in order to board with us.
If your pet was vaccinated at a clinic other than Rowan Animal Clinic,
please e-mail updated vaccination records prior to your pets stay with us to rowananimalreception@gmail.com
Flea and Tick Policy
Pets that arrive with fleas and/or ticks will be administered a treatment at an additional cost. We strive to protect our other guests and kennels from flea and tick infestation
.
FLEAS: In the event that your pet is found to have fleas upon arrival, please choose an option for treatment. This comes at an additional cost.
*
Please administer my pet a flea treatment that lasts for 24 hours.
Please administer my pet a flea treatment that lasts for 30 days.
*Please Note*
In the event that your pet is found to have ticks upon arrival, the only treatment option available is a 30 day treatment.
Medical Care Policies
*Please Note*
These services will come at an additional charge.
Non-emergent Medical Care Policy
In the event that a non-emergent medical problem arises while your pet is staying with us, Rowan Animal Clinic will attempt to contact you, at the emergency contact numbers that were given to us, prior to administering medical treatment. If we have not heard from you within 24 hours, Rowan Animal Clinic will proceed with treatment deemed medically necessary.
*
I have read and acknowledge the above policy in regards to how Rowan Animal Clinic will proceed with care in the event that a non-emergent medical problem should arise.
If we have not heard from you within 24 hours, Rowan Animal Clinic will proceed with treatment deemed medically necessary.
Medical Emergency Care Policy
In the event that your pet has a medical emergency, Rowan Animal Clinic will begin emergency care and attempt to contact you at the emergency numbers that were given to us.
*
I have read and acknowledge the above policy in regards to how Rowan Animal Clinic will proceed with care in the event that a medical emergency should occur.
Additional Services
*Please Note*
These services will come at an additional charge.
Are there any current medical problems that your pet has had or needs to have checked out while boarding with us? Please list any additional service(s) you would like while you pet is boarding with us.
*
Informed Consent
INFORMED CONSENT: I hereby consent and authorize Rowan Animal Clinic to care for my pet in what way they deem appropriate. I understand that by placing my pet in their care that I agree to allow them to use their best judgement in working with my pet. I assume responsibility for injury, loss, or destruction by my pet regardless of the circumstance. By checking the box below, I agree to pay in full for all services rendered via cash, credit card, check, or care credit at the time my pet is discharged. I understand that payment is due immediately upon receipt of the invoice.
*
I acknowledge that I have read the informed consent statement.
Estimate
An estimate of total charges will be provided to you based upon the information on this consent form. I understand that this estimate is meant to APPROXIMATE the final bill but may not be the exact figure of the final bill.
*
I would like to have an estimate e-mailed to me prior to drop off.
I will wait to view the estimate at drop-off.
Submit
