Lodging Check-In Form | Neffsville Veterinary Clinic

Please fill out the following information for your pet(s). If multiple pets are staying with us, please fill out a separate form for each pet.

Your Name*

First Last

Pet's Name*

Drop Off Date*

Drop Off Time

Morning
Evening

Pick Up Date*

Pick Up Time

Morning
Evening

Room

Please fill out the following information for the pet listed above. If multiple pets are staying with us, please fill out a separate form for each pet.

Emergency Contact Information

Primary Phone Number*

Name*

First Last

Secondary Phone Number

Name

First Last

Authorization for Release of Pet to a Person Other Than Owner

If someone other than the owner will be picking up a pet from boarding, please let us know at time of check-in. We will not release pet to anyone other than the owner without prior authorization. Payment for lodging is still required at time of pick up.

Person's Name

First Last

Phone Number

Feeding Instructions

Type of food (select one):*

In-house Hill’s Food
My Own Food

Feed my pet (select one):*

Type of food (select one):*

Wet
Dry
Both

Amount of Food Given (Please use specific measurements)*

EXAMPLE: 2 cups dry with 1 tablespoon wet, 1 pre-packaged dry, 1/3 can wet

cups

cans

pre-packaged

other

When will be their last meal on the arrival date?*

If your pet is not eating, may we entice them? (Parmesan cheese, canned food, etc.)*

Yes
No

Is your pet on a special diet?*

Yes
No

If yea, please specify:

Does your pet have any known allergies?*

Yes
No

If yea, please specify:

Health Questions

Does your pet have any medical conditions we should be aware of?

Has your pet shown any signs of illness or experienced any symptoms in the last 10 days? (Coughing, sneezing, diarrhea, vomiting, etc.)*

Has your pet shown any signs of illness or experienced any symptoms in the last 10 days? (Coughing, sneezing, diarrhea, vomiting, etc

Medication Instructions ($5.00 per day for any lodger on medication)

Is your pet on medication?*

Yes
No

Prescribing Vet Clinic

Medication Name

Reason for Medication:

Dosage on Prescription (EXAMPLE: 10mg, 0.25ml)

Instructions (EXAMPLE: 1 tablet every 12 hours, 2 capsules every 24 hours)

Best Way to Administer (EXAMPLE: in peanut butter, in pill pocket)

Storage/Other Instructions (EXAMPLE: medication needs refrigerated, pills are pre-cut, pills are not pre-cut, etc)

Last Administration

Medication Name

Reason for Medication:

Dosage on Prescription (EXAMPLE: 10mg, 0.25ml)

Instructions (EXAMPLE: 1 tablet every 12 hours, 2 capsules every 24 hours)

Best Way to Administer (EXAMPLE: in peanut butter, in pill pocket)

Storage/Other Instructions (EXAMPLE: medication needs refrigerated, pills are pre-cut, pills are not pre-cut, etc)

Last Administration

Additional Medications (please follow above format/questions)

If your pet is diabetic and on insulin, there is an $11.00 per day charge (in lieu of any other medication charges). This fee covers insulin administration, hazardous waste disposal fees, and monitoring.

Medical Illness Policy

Should your pet become ill or need medical attention, we will call the emergency numbers listed above regarding your pet’s symptoms, treatment options, and estimate of costs. If we find no one can be reached and your pet(s) require(s) treatment to relieve immediate discomfort or to resolve an important medical or surgical condition, we will act based on your wishes indicated*

Please perform whatever services the doctor deems necessary for the best care of my pet until someone can be reached. This includes only non-elective treatments and necessary diagnostics.
I authorize up to $ in medical care for my pet(s) until someone can be reached.
Do not administer any medical treatment until specific authorization is given. I understand my pet will NOT be treated.
In case of a life-threatening emergency, please acknowledge what actions you would like our hospital team to perform:
CPR (Cardiopulmonary resuscitation)
DNR (Do not resuscitate)

Please indicate the amount:

May we take photos/videos of your pet and share them on social media?*

Yes
No

Should your pet experience GI upset during their stay, would you like us to feed Hill's Gastrointestinal Biome Diet? This is a prescription food that uses ActivBiome technology proven to soothe your pet's GI tract and promote the growth of beneficial gut bacteria. (Charge of $3/day)*

Yes
No

Lodging Stay Enrichments

All dogs will receive 4 walks per day and cats receive time in the kitty park and a coat brushing (if your cat allows us!). We will provide your pet with any additional services you choose. If your pet does not enjoy the activities selected, we may provide alternative enrichment at our discretion.

Enrichment Options

Play Time (10 minutes)
Snuggle Time (10 minutes)
Extra Walk Time (10 minutes)
Pet Postcard to your E-mail Address

How many of each activity? (NOTE: 2 per day maximum)

Would you like your pet to participate in our play partners program in which they would be evaluated and may or may not be approved to play with other dogs?*

No
Yes (The Play Partner Evaluation is a one-time fee of $32. If your dog is already approved, please select regular play time and we will pair them with a friend!)

Would you like your pet (dogs only) to have any treat Kongs while staying with us?*

Flavors - peanut butter, pumpkin puree, i/d wet food

Spa Services

Would you like your pet to receive any spa services while lodging with us? (For additional services [ex: hair cut] an appointment with one of our groomers must be scheduled by calling the main clinic telephone number.)*

Abandoned Animals Protocol

No pet shall be released until all charges are paid in full. The pet owner agrees to notify NVC Pet Resort staff in advance if there is any change in the departure date and time. Any pet left unclaimed for (7) days from the scheduled checkout date shall become the property of NVC. Fees incurred for the care of unclaimed pets will be turned over to collections. The pet owner or his agent agrees to pay reasonable legal fees and costs incurred by NVC in the collection of outstanding bills. The owner or his agent also agrees to pay for any site damages beyond normal wear and tear incurred by his pet(s).

Healthy Environment

In order to maintain a healthy and “flea free environment”, your pet will be checked for fleas upon admission. If fleas are present, your pet will be treated with flea medication (at the Doctor’s discretion) at your expense. All lodging guests are required to be current on required vaccinations and a fecal analysis.

Neffsville Veterinary Clinic (NVC) agrees to exercise due and reasonable care and to keep the premises sanitary and properly enclosed. Pet(s) will be fed, watered regularly, and housed in safe, clean quarters. The NVC Pet Resort is staffed with attendants from 6am to 9pm. We do not have an attendant overnight.

The services provided are done so without liability for loss or damage from disease, death, running away, theft, fire, and from injury or damage done by animals to people, other animals (including bites, scrapes, lacerations, or puncture wounds), property, or other unavoidable circumstances. Diligence and care have been exercised in preparing a safe facility for pets. The undersigned releases NVC, its owners, and employees from all risks and damages which may occur during lodging. Employees reserve the right to separate or move above pet(s) to another area of the facility should they deem it necessary, and this may incur additional charges. Neffsville Veterinary Clinic will not be held responsible for any lost, damaged, or soiled items.

Check-in / Check-out Times Monday-Friday: 8am-11am or 4pm-7pm
Saturday: 8:30am-11am or 3pm-5pm
Sunday: 10am-12pm or 3pm-5pm
Outside of these times we are caring for our lodging guests and appreciate your cooperation.

I have reviewed and concur with all check-in information. I agree to pay for the above selected services and nightly lodging. (signature)*

Date*