Medical Boarding Drop Off Questionnaire

  • Date Format: MM slash DD slash YYYY
  • Medications/Treatments/Special Accommodations:
  • 8. Has your pet exhibited any of the following problems?
  • Emergency Phone Numbers:

  • I, the undersigned, (i) do hereby certify that I am the owner (or the duly authorized agent for the owner) of the animal described above (the “Pet”), (ii) do hereby consent and grant the veterinarians of Calvert Veterinary Center and all of their employees, agents, servants, and/or representatives (collectively, the “Hospital”) full and complete authority to perform the services described as: SEE ESTIMATE and to perform any other procedure that, at the attending veterinarian’s discretion, may be deemed useful or advisable to promote the health of the Pet, and (iii) I do hereby forever release and discharge said Hospital from any and all liability arising from said procedure on said Pet.

    As the owner of the Pet, I realize that I am responsible for the boarding fees, and any associated costs, and for the payment of services listed below and that they are to be paid in full at the time the pet is discharged. I also understand that if I do not provide enough medication for my pet that Calvert Veterinary Center will need to have the medication refilled for me. I further understand that if Calvert Veterinary Center does provide a refill of my pet’s medication, that I will be responsible for paying for the medication upon my return when I pick up my pet. If I do not pick up the animal within five days of the scheduled pick up date, the Hospital will assume the animal is abandoned. If the animal is abandoned, the Hospital is authorized to remedy the abandonment as prescribed by law. I further understand that abandonment DOES NOT release me of my financial obligation for the services rendered, fees associated with abandonment, collection action, and/or legal services.

    Calvert Veterinary Disclosure Form

    Please read carefully before signing. Calvert Veterinary Center has business, medical, and staffing hours: Monday through Friday 7:30am – 7:30pm Saturday 8am – 1pm; Sunday Closed Therefore, this is to inform you that we have no in-house continuous medical staff care overnight, weekends, or on holidays after closing time. Continuous medical care will resume on the following business day according to the above schedule. We provide weekend and holiday care on a regular but intermittent basis only. Payment for all services must be made at the time of discharge from the hospital. We will discharge boarding patients during our normal business hours only. Flea Policy – All boarding pets must be free of fleas. If your pet has fleas they will receive a bath, oral flea treatment, and topical flea preventative. The additional charge will be added to your final bill. Vaccination Policy – To insure the protection of all pets under our care, the following vaccinations must be up to date: Dogs: DHPP (Distemper) Bordetella (Kennel Cough) Rabies Cats: FVRCP (Distemper) Rabies Feline Leukemia (or proof of negative test within previous 12 months) If my pet is not current on all above vaccinations, I give my permission for Calvert Veterinary Center to update the vaccination(s) in accordance with the above policy. I understand an examination fee will be charged as well as the vaccination fee to my final bill. Medical Illness Policy –One of the advantages of boarding your pet at Calvert Veterinary Center is that veterinary attention is readily available should the need arise. If your pet becomes ill, we will call the emergency number(s) listed regarding your pet’s symptoms, treatment options, and estimate of additional costs. If no one can be reached however, we at Calvert Veterinary will perform whatever services the doctor deems necessary for the best care for your pet until someone can be reached. This includes only non-elective treatments and any necessary diagnostics. I have read this form and I am aware of the above staffing hours and understand the above Flea, Vaccination, and Medical Illness policies. I agree to pay for any additional fees necessary to be in accordance with the above policies.

    Medical Boarding Release
  • does have an existing illness and that they will be unattended at times and may develop complications from their illness that may have unfavorable results while unattended. While Calvert Veterinary Center will do it’s best to care for my pet while they are here I will not hold Calvert Veterinary Center or it’s staff responsible for any complications or conditions that may arise while my pet is unattended.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY