Boarding Instructions

Drop off Date

Date

I will pick up on:

Date*

I can be reached at*

If I cannot be reached, call:*

Email address, in case we cannot reach you by phone

Optional

How Many Feedings Per Day*

Instructions*

Medications To Give: (Additional Fees Apply)

Medication & Next Due Doses:

Please specify

Medical problems we should be aware of

Please complete the evaluation questionnaire

Selected days (specify dates)*

Items Left

MEDICAL EMERGENCY AUTHORIZATION:

I am the owner/authorized agent of the animal described below and authorize Old Dominion Animal Health Center (ODAH Center) to provide services as necessary to preserve the pet’s life and well-being, and I absolve and release ODAH Center from any loss, expense, or liability arising from the performance of these services. In the event of a medical emergency, outside of regular hours, ODAH Center may transport the pet to a 24-hour emergency clinic, and I authorize ODAH Center staff members to grant permission for diagnostics and treatment at that facility until I am able to be contacted. All fees incurred at that 24-hour emergency clinic and/or ODAH Center, as well as all liabilities or losses are the sole responsibility of the owner or agent. I understand that the center is closed and not medically staffed outside of regular business hours.

Pet’s Name*

Email*

Date

Signature*

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Comments

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Boarding Form

Boarding Form

Drop off Date

Medications To Give: (Additional Fees Apply)

MEDICAL EMERGENCY AUTHORIZATION:

Request an Appointment

Address

Contact Information

Hospital Hours

AFTER-HOURS EMERGENCIES

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