Boarding Consent Form

Welcome to Animal & Avian Medical Center!

We’re so glad that you’re here!

Complete your Boarding Consent Form online at your convenience.

Client's Name *

First

Last

Phone *

Email *

Pet's Name *

Species *

Dog
Cat
Other

If other, please specify *

Breed *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Age/Date of Birth *

Drop-Off Date *

Pick-Up Date *

Has your pet been diagnosed with any medical conditions? *

If yes, please specify *

Is your pet on any medications? *

Please list (drug, strength, dose, & frequency. Example: Flagyl 50mg, Give 1 tablet AM, 1/2 tablet PM). Please note there is an additional charge for medication administration per day. *

Please list your pet's diet and the amount and frequency. Please note, standard care consists of food offered twice daily. If your pet has additional needs, there may be an additional charge. *

Please list all items that were brought in for boarding today to be returned at discharge. Please note, while we take every effort to ensure all items returned at the end of boarding, Animal & Avian Medical Center is not responsible for any damaged or lost items that are left during the boarding stay. *

Are there any additional items or services you need during the·duration of your pet's stay with us? *

If yes, please specify *

In the case of an emergency or illness, we will contact the person listed below regarding symptoms, treatment options, and estimate of additional costs. If no one can be reached however, indicate your wishes below should your pet require treatment to stabilize and relieve immediate suffering or discomfort.

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Until someone can be reached, I authorize one of the following: *

Do not administer treatment until specific authorization. I understand that by refusing treatment until someone can be rec;tched, may result in, but not limited to, further deterioration of their condition and/or death.
Until someone can be reached, I authorize up to the following amount to be spent on treatment (specify below)
I authorize any treatment deemed necessary by the veterinarian, and accept the charges associated.

I authorize up to the following amount to be spent on treatment: *

Animal & Avian Medical Center will use all reasonable precautions against illness, injury, escape of my pet, and/or loss/destruction of personal items. I will hold Animal & Avian Medical Center and staff free of all responsibility and/or liability in the absence of gross negligence. I realize that I am responsible for payment of all above mentioned procedures, treatments, and boarding charges in full at the time of my pet's discharge. I understand if! neglect to pick up my pet within five (5) days of written notice that they are ready for release and mailed to the above address, Animal & Avian Medical Center will consider them to have been abandoned and will be handled in accordance with state law. I further understand that such actions will not release me from paying all costs of boarding and hospital services. I will be responsible for full payment, and any associated billing, of any and all services rendered to my animal. I understand that even though is a hospital, it is not a 24 hour facility. Therefore there are periods of time during the night and on weekends when the hospital is not staffed. I realize that if needs 24 hour care, I have the option of transporting him to an area emergency clinic. *

I have read and understand

Today's Date *

Welcome to Animal and Avian Medical Center!

Fill out the form below, and a member of the team will get back to you as quickly as possible. Our staff monitors messages as closely as possible during our business hours, but if it is an emergency, or you need a prompt response please call the clinic directly to speak with us.

Contact

Phone: 330-225-0095
Fax: 330-225-8236
Email: info.aaamc@gmail.com

Hours

Mon-Fri: 8:00 am - 6:30 pm
Sat: 9:00 am - 3:30 pm
Sun: Closed

Address

4171 Center Road
Brunswick, OH 44212
Click here for directions.