Boarding Information Form Boarding Information Form Current Date * Boarding From * Boarding To * Owner's Name * Owner's Name First First Last Last Phone * Email * If the need should arise to contact you, what state or country will you be in while your pet is boarding here? * Pets Boarding If boarding for more than 3 weeks a 50% deposit is required at time of boarding. Depending on length of stay monthly payments may be required.* Pet's Name * Pet's Species * If avian species, Is your bird flighted? Yes No plus1 Add another pet minus1 Remove a pet DIET--If pet(s) require different diets please list each pets name and diet * I understand that should need arise to purchase food for my pet other than the diets normally provided by Avian & Exotic Animal Hospital of Louisiana, those items purchased will be added to my boarding bill * I understand Owner’s Belongings: (We are not responsible for items left over 30 days) Medication Amount Given Last Time Given plus1 Add another medication minus1 Remove a medication Food/Treats Bowls/Dishes Blankets/Towels Cages/Carriers Miscellaneous Items I approve the following checked services and applicable fees to be performed while my pet is boarding: Bath Microchip Surgical Sexing(Avian) DNA Sexing (Avian) Clip Wings Clip Nails Trim Beak Physical Exam Reptile Sexing Blood Chemistry Profile If fleas/mites are noted on pet upon intake, I agree to pay the charge of $21.00 -$68.00 for treatment. * I agree If it should become necessary for us to contact you and we can't reach you on the number listed please include an alternate name/number of someone we can reach that can contact you. Name * Name First First Last Last Phone * In case of a natural or man-made disaster (hurricane, flood, tornado, fire, etc), the person(s) listed below are authorized to pick up my pet(s). Name * Name First First Last Last Phone * plus1 Add another person minus1 Remove a person If a disaster occurs and your pet requires evacuation, a one-time fee of $105.00 will be imposed to cover travel expenses and van rental * I understand If non-critical services (i.e. Grooming, Bloodwork, Xrays) are found to be needed while boarding would you like to be contacted for approval of additional service * Yes No I understand if approved applicable charges will be added to my boarding fees * I understand In the event that my pet(s) should become ill while boarding and I cannot be reached, I hereby authorize the veterinarians of Avian & Exotic Animal Hospital of Louisiana to administer treatment. I understand that I will be financially responsible for all laboratory and treatment charges in addition to the boarding fees. * I authorize Signature of person responsible for payment * signature keyboard Clear Date * If other than client, name and relationship to client LONG TERM BOARDER I am boarding my pet(s) for more than 3 weeks and understand that a 50% deposit must be made at time of boarding and that I must make monthly payments during my pet's stay. I understand For ease of payments a "Held Credit Card Agreement Form" can be completed and AEAH will charge your account on a monthly basis until your pet is picked up. If interested, please inform receptionists that you wish to complete a "Held Credit Card Agreement Form". Submit If you are human, leave this field blank.
