[ Client Resources ] Boarding Check-In Form Boarding Check-In Form Owner's Name * Owner's Name First Name First Name Last Name Last Name Owner's Email * Date In * Date Out * Please select one of the options below * Single ($35.00/night) Double ($55.00/night) Double is required for cats over 14 pounds or hard to handle cats. Cat's Name * Diet (what, how much, how often) * We provide Science Diet Original Adult dry food. Any other food must be provided or purchased. Fancy Feast cans are available for an additional $4 per day. Meds (what, how much, how often) The fee for administering owner provided medications is as follows: $2.90/day up to two meds $4.40/day for 3 meds $5.70/day for 4 or more meds $35.70 each time for Sub-Q fluids Permissions May we post vacation pictures of your cat on Facebook? * Yes No May we text you vacation pictures? * Yes No Owner's Phone * Emergency Contacts Person to contact in case of an Emergency * Person to contact in case of an Emergency First Name First Name Last Name Last Name Phone * Alternate Emergency Contact Alternate Emergency Contact First Name First Name Last Name Last Name Phone May the emergency contact make decisions regarding your cat on your behalf? * Yes No For Your Cat's Health EXAM POLICY: All new boarders who are not current patients of Cat Care Clinic will receive an exam at the beginning of their stay and every two years thereafter. VACCINATION POLICY: To ensure the protection of all cats under our care, all cats must be up to date on Rabies and FVRCP (upper respiratory) vaccines. If you are unable to provide proof of vaccination, we will update those vaccinations in accordance with this policy. An exam fee will be charged in addition to vaccinations. EXTERNAL PARASITES: A fecal test is required to have been performed in the last year, or we will perform one during boardingFLEAS! If your cat has fleas or other parasites, he or she will be treated at your expense. MEDICAL ILLNESS POLICY: If your cat(s) becomes ill, we will call the emergency number(s) listed above regarding your cat’s symptoms, treatment options and estimate of additional costs. If no one can be reached, your cat will be treated as deemed best by the doctor and you will assume full responsibility for the treatment expense involved. HURRICANE POLICY: In the case of a hurricane or other natural disaster, you will be responsible for evacuating your cat. We must put the safety of our staff first and we may not be in position to care for your cat during or after a hurricane. Signature * signature keyboard Clear Date * Special Instructions YEARLY Annual Exam Semi-Annual Exam Yearly Labwork FeLV FVRCP Fecal Rabies GROOMING Bath Belly Shave Nail Trim Brush Out Sani Lion Cut De-Mat LION CUT Mane -Select One-N/AShortMediumLong Boots -Select One-N/AShortMediumLong Tail -Select One-N/AFullPoof Sedation Yes No If yes, please read and sign below. Sedation Consent PRE-ANESTHETIC EXAM AND BLOOD TESTING: There is always a risk associated with anesthesia, regardless of the procedure to be performed. Most, but not all of these risk factors can be determined by a complete physical examination and pre-anesthetic blood testing. ANESTHETIC COST: Each anesthetic procedure is designed specifically for your individual cat. The procedures and the agents used vary considerably depending on several variables including the age and medical history of your cat, and on the length and type of procedure being performed. Resuscitation Orders Agreement Resuscitation Orders in the Event of an Emergency: For every cat in our care, we need to know, in advance, what your wishes are in the unforeseen event of an emergency if he or she stops breathing and/or their heart stops beating. CPR has the best chance of being successful if started immediately. We will make every attempt to contact you right away should your cat require resuscitative efforts. Please review and select one option below. Cardiopulmonary Resuscitation (CPR): All resuscitative efforts including placing a breathing tube, providing chest compressions and IV medications are to be attempted to restore normal heart function and breathing as deemed necessary by the doctor until I can be reached. Should my cat require cardiopulmonary resuscitation (CPR), I request that the doctor(s) pursue such medical care indicated above. I understand that this is a cost in ADDITION to any estimate and agree to pay this fee. The cost of full CPR is typically an additional $300 - $500 or more. Patients who are successfully resuscitated are often critical and will require transfer to a 24-hour facility for at least 24 to 48 hours of intensive care and monitoring following resuscitation. Do Not Attempt Resuscitation (DNR): Aside from reversing any reversible sedatives or anesthetic drugs that have been administered, no cardiopulmonary resuscitation (CPR) efforts are to be attempted allowing natural death. Be assured that we do everything possible to prevent this from happening and electing DNR does not affect selected treatments. Please select one of the following * Cardiopulmonary Resuscitation (CPR) Do Not attempt Resuscitation (DNR) Authorization: By signing below, you are verifying that: I am the owner or agent for the owner of the above-described cat. I understand that during the performance of the ensuing procedures(s), unforeseen conditions may be revealed that necessitate an extension of the ensuing procedure(s) or different procedure(s) than those set forth above; therefore, I hereby authorize the performance of such procedure(s) as are necessary in the exercise of the veterinarian’s professional judgment. Signature * signature keyboard Clear Date * Submit If you are human, leave this field blank.