North Reading Veterinary Clinic / Boarding Release Form

North Reading Veterinary Clinic

212 Main St.
North Reading, MA 01864

(978)276-3203

www.northreadingvet.com

Boarding Release Form

In the case of illness or injury, I the undersigned, do hereby give my consent for the doctors of the N.R.V.C. to treat, prescribe medications for, and/or perform surgery upon my pet(s), if needed while they are being boarded at the N.R.V.C.

***If medications are prescribed or surgery is performed on your animal, you will incur added charges; for administering medications, you will be charged a "Medical Board" charge ($2.00 extra per day).

I understand that N.R.V.C will use all reasonable precautions against injury, illness, or escape of my pet(s), but will not be held liable for any circumstances on account of the care, treatment, or safe keeping of my pet(s), as it is understood that I assume all risks.

Should the circumstances arise that my pet(s) remain(s) unclaimed after the date which I have stated as the pick-up date, I understand that written notice will be mailed to my address. If my pet(s) remain(s) unclaimed for ten days after written notice, it will be considered abandonment, and the N.R.V.C. will assume ownership of the animal(s). It is further understood that such action will not relieve me of paying all costs of service and the use of the hospital, including the cost of boarding service.

Vaccination & Fecal Requirements

Canine

Rabies

DAPP/L4

Kennel Cough/Bordetella

Negative Fecal

Feline

Rabies

FVRCP

Negative Fecal

Boarding Release Form Form

Pets Name (required)

Description (required)

Drop Off (required) :

Pick Up (required) :

***
N.R.V.C. reserves the right to call you or your emergency contact if we are unable to accommodate your pet(s) needs due to aggressive behavior.

***
If we are unable to reach you or the emergency contact, we reserve the right to transfer your pet(s) to another facility that is able to handle their special needs.

Please give description of feeding instructions for your pet. (required)

Have there been any unusual signs/symptoms that we should be aware of while boarding your pet? (required)

Does your pet have any medical problems that require special care? (required)

Please list medications your pet is currently taking, with instructions. (required)

Any health concerns? (required)

Is your pet current on Flea / Tick prevention? (required)

Yes
No

If yes, What Brand?

Please give a detailed description of any belongings you brought for your pet. (required)

***
We do our best to make sure your pet(s) belongings go home with you, but please be aware that we cannot be held responsible should something get lost or damaged.

Is your pet current for the vaccines listed below?

Yes
No

Vaccines
Rabies
DAPP/L4
Kennel Cough
lyme
Fecal
HWT/4DX
FVRCP
FELV
Other

We will need to see written proof that your animal is current for any vaccines given elsewhere.
Any REQUIRED vaccines that are overdue must be done while your pet is here. Those due for annual exams will also be charged an in-house EXAM FEE of $55.50.

Will your pet need a nail trim? (Additional Fee) (required)

Yes
No

PLEASE NOTE:
In the case of illness or injury, I, the undersigned, do hereby give my consent for the doctors of the N.R.V.C. to treat, prescribe medications for, and/or perform surgery upon my pet(s), if needed while they are being boarded at the N.R.V.C.

If medications are prescribed or surgery is performed on your animal, you will incur added charges.
For administering medications, you will be charged a "Medical Board" charge ($2.00 extra per day).

I HAVE READ THE ABOVE AND UNDERSTAND THAT I ASSUME ALL FINANCIAL RESPONSIBILITY FOR ALL SERVICES RENDERED.
I ALSO UNDERSTAND THAT PAYMENT IS DUE WHEN MY PET IS DISCHARGED.

I have read and understand the above statement.

Name (required)

First Name (required)	Last Name (required)

E-Mail Address (required) :

Phone (required)
Phone Type	Phone Number (required)

Emergency Contact Information (Name, Phone) (required)

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Hours of Operation:

Monday	8 am -	6 pm
Tuesday	8 am -	7 pm
Wednesday	8 am -	7 pm
Thursday	8 am -	7 pm
Friday	8 am -	6 pm
Saturday	8 am -	4 pm
Sunday	Closed