Dupage animal hospital

Dr. Gary Maves, Dr. Mary Felt, Dr. Angela Clark, Dr. Nicole DiGiacomo, Dr. Allison Roberts, Dr. Christopher Obradovich Owner’s Name: ___________________________ Pet’s Name: ____________________________
Date of Drop off: _____/______/________
Date of Pickup: _____/______/________

Feeding Directions:
Brand of Food

Vaccine Policy: To insure the protection of all pets under our care, written proof of the following vaccinations
must be presented at time of boarding. If proof of vaccines is not available, the following procedures will be given
at owner’s expense, including a wellness examination fee of $51.00. Please Initial.

CANINE:
*Rabies (DuPage Co $34.70)_______
*Note: Rabies price is for 1-Year vaccine (Neutered/Spayed price)
DHLPP ($29.75) ____ DHPP ($17.25) ____ Lepto ($15.65)____ Bordetella ($31.50)____ Fecal ($24.00) ___
FELINE:
*Rabies (DuPage Co $37.15)_____
*Note: Rabies price is for 1-Year vaccine (Neutered/Spayed price) FVRCP ($16.50) ___ Fecal ($24.00) ___ Other optional services that we offer:
Dog Nail Trim ($16.75) ___ Cat Nail Trim ($13.50) ___ Anal Gland Expression ($31.25) ___ Heartworm Test ($39.00) ___ Feline Wellness Blood Panel ($66.85) ___ Canine Wellness Blood Panel w/ Heartworm Test ($89.50) ___ --------------------------------------------------------------------------------------------------------------------------------------- Special Care: We give conscientious, affectionate, and individualized care to pets left in our trust. If your pet has
special needs please advise us. Please also list out any particular behaviors that we should be aware of (example:
dislike of other animals, will chase birds, afraid of storms, etc.) All boarders receive a free minor exam by the
veterinarian.
Brief history of any problems:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please list any medications your pet may be on along with current directions & time last dose was administered.
Note: An additional charge of $5/night will be added for administering medication. Initial _________
Medication:
Directions:
Time Dose Was Given Last:
Boarding away from home can cause some pets to develop an upset stomach which can lead to diarrhea. If your pet develops diarrhea, a medication called Flagyl, an intestinal antibiotic, can relieve the symptoms. We can start this medication (at a doctor’s direction) for an additional cost. If my pet begins to have diarrhea (please initial): _____ I authorize DuPage Animal Hospital to administer Flagyl to my pet. _____ I do not want Flagyl administered to my pet. Do you currently use a flea preventative on your pet? If yes – what type do you use? ______________________ When was it applied last? ________________________ We are an intake facility for Villa Park, Elmhurst, and Wood Dale police departments. Because the police are allowed to drop off strays animals 24/7, we are not always here to check them for fleas. In order to provide the best care and protection for your pet, we would like your permission to apply Advantage, a topical flea preventative, at an additional charge, if your dog is not current on a flea preventative. _____ I authorize Advantage to be applied. _____ I do not authorize Advantage to be applied. _____ I authorize a different kind of preventative to be applied: ________________ In the event that my pet becomes ill, I authorize DuPage Animal Hospital to render medical care, which it deems as necessary. I request that every reasonable attempt be made to reach me or my agent at the phone number below, and I assume financial responsibility for all charges incurred. Signature: X____________________________________

Emergency Contact #1: _______________________________ Phone: _____________________
Emergency Contact #2: _______________________________ Phone: _____________________

Please call before picking up your pet to make sure they are ready to go home. Possessions:_________________________________________________________________________ ________________________________________________________________ Kennel Initial: _________

Source: http://dupageanimalhospital.com/clients/9595/documents/Boarding_Agreement_-_2014.pdf