Boarding Information/Release Form

Boarding Information/Release Form 9540 Dublin Road Powell, Ohio 43065 (614) 389 6455 www.shawneehillsvet.com stay-n-style@shawneehillsvet.com Thank you for trusting us to care for your furry friend while you are away. To help us make the drop off and pick up process smooth for both you and your pet, please follow the guidelines below. We do ask that all paperwork be completed to the best of your ability before arrival to help prevent miscommunication about your pet's needs. Forms can be found at http://shawneehillsvet.com/services/boarding/. We will also email you the forms for you to print, complete and bring with you. Required paperwork includes boarding information/release form, CPR directive, boarding admission form/kennel form and medication/supplement log (if applicable). Please read the following boarding policies and protocols carefully: Drop off and pick up times: Our hospital hours of operation are Monday Friday 7:30 AM to 6:30 PM and Saturday 8:00 AM to 2:00 PM. Our new dog boarding and grooming facility now share an entrance in our lower level. Cats will still be dropped off in our main hospital entrance unless they are in the same family as a dog boarder. If together, both can enter the lower level boarding area and the kitty will be taken to our upstairs cat boarding facility. To facilitate the process, we ask that drop-off and pick-up times be scheduled during these hours: o Monday through Friday 8:30 AM 11:00 AM or 3:00 PM 5:00 PM o Saturday 8:30 AM 11:00 AM o Sunday by prearrangement at 4:00 PM (pick-up only) Please be advised that our dog pet guests are walked between 11:00 AM 1:00 PM and 4:00 PM 6:00 PM, therefore a drop-off and pick-up time must be scheduled in advance to best serve you and your pet. Special arrangements may be made if a drop-off time is needed after 5:00 PM (Monday Friday) or 11:00 AM Saturday, but no drop offs or pick-ups can occur after 6:00 PM. Sunday pick-ups are 4:00 PM by prearrangement. Regardless if you pick-up your pet on Sunday or Monday, it is still the same cost to board him/her. Dogs will be released in the lower level and cats in the main hospital entrance. If your dog and cat are both boarding, both may be picked up in the lower level. We will call the day before your pet's scheduled stay to verify the reservation and confirm your boarding admission time. Boarding Prices: Kennel Type Size Price per pet per night Cat Condo - $15 Dog Standard Kennel Single pet <20lbs $23 Dog Medium Kennel Single pet <45lbs or two $27* small pets <20lbs Dog Suite (5 x 6 ) Multiple smaller pets or $33* large dogs Medication given/day - $5 *10% discount per day for each additional dog in the same space

Personal Belongings: We will provide everything your pet needs including food and water bowls, blankets, towels, and cots to lie on. o Food: We feed Purina EN gastrointestinal dry food for dogs and cats. If your pet is on a special diet or you want to keep him/her on their current diet please bring only enough food for your pet s stay. Large bags and food bins are difficult to store. Pre-packaged feeding amounts in sealed baggies are always welcome. For cats, small cat food bags or tupperware containers are small enough to be stored in the cat condo. Cats are fed either free choice dry or measured amount twice daily. If your dog or cat is normally fed more frequently than twice daily, please note on the boarding admission form. Feedings coincide with our morning dog walking and late afternoon dog walking (7:00 AM 8:00 AM and 5:00 PM 6:00 PM). o Treats: You may bring treats to be given at various times of the day. Generally, treats are given at dog walking times and before bed. These times are the same for the kitties. If your cat enjoys catnip we have plenty on hand! Bedding: We provide blankets, towels and cots for your pet s comfort. Bedding is washed daily for both cats and dogs. You are welcome to bring your pet's bedding, but it is not necessary. Many dogs will soil and/or chew on their nice comfy beds brought from home, especially if they are not accustomed to boarding. Our utmost concern for your pet is their safety; dogs that chew up any bedding while boarding will not be able to have any bedding to avoid a foreign body blockage. Please be advised that if you bring your pet s bedding it may be soiled on, mixed up in our laundry facility or damaged. Large beds cannot be washed in our machines and small beds run the risk of becoming damaged during the cleaning process. Consider bringing something smaller that smells like home such as toy. If your cat enjoys sleeping in boxes, we do provide cardboard boxes for kitty relaxation. Toys: Please bring a few toys that are indestructible. Stuffed animals are not advised as a dog that gets bored or stressed in the kennel may begin to pull it apart and ingest the stuffing. Be advised that toys and bones may be lost or misplaced during their stay. We encourage you to bring a few of your cat s favorite toys. Please label everything clearly to reduce the chance of the toy being misplaced. Medication: If your pet is on medication or supplements, please fill out the Medication and Supplement Form before your arrival to save you time and be sure that there is no miscommunication with your pet's needs. All medication MUST be in the original prescription bottle. We will not accept medication in plastic bags, weekly or daily pill boxes or any other container other than the original prescription bottle. For controlled substances (Phenobarbital, Tramadol, Hydrocodone tabs, Torbutrol tabs, Diazepam etc.) we ask that you only bring enough for your pet's stay, in the original container. We will count these medications upon your pet s arrival and departure. Any additional medication not needed during their stay may be sent home with you at the time of drop-off. Medical Services: If your pet needs medical services while boarding, please make these arrangements prior your pet s boarding admission time by calling the office to discuss what services your pet needs. An appointment will then be made for your pet on our medical schedule while your pet is with us. The client care specialist will notify you at the time the reservation is made if vaccines need updated while your pet is with us and an estimate for the procedures will be emailed to you prior to your arrival for approval. Grooming: If you would like to have your pet groomed while boarding, please make these arrangements ahead of time as soon as you know you need your pet boarded. Schedule both the boarding and grooming at the same time. If the boarding reservation is short notice, grooming may not be able to be provided. We will do our best to accommodate in these situations. We groom dogs Monday - Saturday. Cat grooming is every other Wednesday. Extra TLC: Your dog will be walked in our fenced in yard four times daily and your cat will have an

opportunity to lounge the kitty boarding room to sit in the window/relax on the cat tree. If you would like your dog to have some off leash exercise (playing ball or tossing a toy), or extra cuddle time brushing or a belly rub for both dogs and cats, please let our staff know. There is an additional fee for each 20 min of TLC. This service is subject to staff availability and may not always be possible during your pet s stay. Vaccination Requirements: I understand that Animal Hospital of Shawnee Hills (AHSH) requires all dogs boarding with us to be current on their rabies, distemper, parvo & 6-month bordetella vaccinations as well as a negative fecal check within the past three to six months. All cats must be current on their rabies and distemper vaccinations. If vaccines or a fecal check were completed elsewhere, it is the owner s responsibility to provide evidence of this prior to boarding admission. If our records show that your pet is not current on required vaccines, we will provide you with a treatment plan cost to vaccinate your pet and our veterinarians will vaccinate your pet upon arrival. This cost will be added to your pet s invoice. If your pet cannot have vaccines for any reason, he/she will stay in our upper level hospital boarding room away from other pets (if available). This will be considered medical boarding with applicable fees as veterinary technicians will care for your pet during business hours. We reserve the right to refuse any dog or cat that is not current on vaccinations. Infectious disease protocol: We will isolate animals with known contagious diseases whenever possible. Cages and runs are cleaned daily, if not more often, with an antibacterial/virucidal disinfectant. All team members are required to wash their hands in between patients. All pets must be current on flea prevention. Dogs must be current on intestinal parasite prevention if not current, a negative fecal check within the past three months is required upon admission. In spite of our best efforts, occasionally an animal will leave our hospital and develop an upper respiratory infection, cough or some other illness. This is an inherent risk of boarding, but especially in a veterinary facility where we see sick patients on a regular basis. Flea inspection: I understand that my pet will be inspected for flea evidence upon boarding admission. Treatment is required at my expense if flea evidence is confirmed. We highly recommend that your pet be current on flea prevention before boarding at our facility. Emergency care: I have read, understand and chosen a CPR code and treatment directive for my pet during his/her stay at Animal Hospital of Shawnee Hills. I hereby authorize the AHSH to perform any emergency procedure(s) or test(s) on my pet while in their care as chosen. I understand that the AHSH will not be held responsible for injuries, illnesses, or loss of the above pet if said injuries, illness, or loss occur while in the course of normal routine care. o Although it is hard to discuss this matter, we want to follow your wishes should your pet be in a situation where our veterinarians feel your pet should be humanely euthanized due to your pet s quality of life. If you cannot be reached by telephone or e-mail in a timely manner, nor can your emergency contact be reached, please choose one of the following options: I give permission for the veterinarians at AHSH to humanely euthanize my pet in his/her best interest. Your signature: I do not give permission for the veterinarians at AHSH to humanely euthanize my pet and wish for him/her to pass naturally. Your signature: I have read and understand the policies and protocols to board my pet at the Animal Hospital of Shawnee Hills. By signing below, I agree to comply with the described requirements. Signature: Date:

Animal Name: Female Male Color: Breed: Owner Name: Date In: Date Out: Warnings/Allergies: Owner Phone Contact: Owner Destination: Emergency contact name/phone number: Feeding Instructions Own Food In House Food Amount: Frequency: Treats Amount: Frequency: Collar Leash Harness Bed Blanket Personal Belongings Food Treats Toys Other: Medications Yes No **See Medication Sheet** Services to be performed Fecal Sticker (Staff Use Only) Vaccines Grooming Appointment Date (if available): Exam: (Explain) Nail Trim Estimate Provided Pet Monitoring Log For Staff Use Only CPR Code 1 or 2 (Circle one)

Medical Treatment Consent/Decline Directive In the unlikely event that your pet will require emergency medical treatment while in our care please read the following directive and choose one of the options below. An emergency may consist of, but not limited to the following: seizure, acute collapse, vomiting, diarrhea, allergic reaction (anaphylaxis), cuts/scratches/punctures (bite wounds with same-family pets housed in same kennel), diabetic emergency, or cardiac arrest (older pets). If my pet,, has a non-life threatening medical emergency while in the care of the Animal Hospital of Shawnee Hills please: (please check one) I do not wish for my pet to be treated for a non-life threatening condition without my consent. Call me before any procedure is performed for verbal consent if my pet is stable and a non-life threatening event has occurred. If I cannot be reached by phone, please treat my pet as the veterinarian sees fit should a non-life threatening event occur. I understand that additional costs will be incurred. If my pet has a life-threatening medical emergency while in the care of Animal Hospital of Shawnee Hills please: (please check one) During a life threatening medical emergency, DO NOT perform measures to stabilize my pet until I can be reached via phone. I understand that these if my pet does not receive immediate medical attention during a medical emergency, he/she may pass away. Perform measures to stabilize my pet until I can be reached via phone during a life-threatening medical emergency. I understand that these measures will be at an additional cost to the previous estimate. In addition, I have been informed that if my pet stops breathing or heart stops beating they will require CPR unless otherwise directed below. I realize that even the most successful CPR may not restore him/her to good mental and physical health. In addition to the limited likelihood of success from CPR treatment, I understand that such care requires that I pay additional fees. I accept that if the hospital staff is unable to reach me within twenty (20) minutes after the initiation of CPR and after administering reasonable treatment there appears to be virtually no hope for medical success, CPR will be withdrawn. If my pet requires emergency resuscitation measures (CPR) please do the following: (please check one) Level 1: Do not perform CPR on my pet. I decline CPR for my pet. Level 2: Perform CPR by placing an Endotracheal Tube for positive pressure respiration, administer emergency drugs, place an IV catheter for fluid support and drug administration, external cardiac massage (chest compressions) Fee range $150-$300

If my pet has a medical emergency and is stabilized by the staff as indicated above, but requires additional specialty care, please take the following steps for my pet s care: (please check one) If my pet requires specialty care, and I cannot be reached, please transfer my pet to OSU main, OSU Dublin or MedVet (please circle one). Transport fees will apply along with any medical care provided before transport. If my pet requires specialty, and I cannot be reached, I do not wish my pet to be transferred to an emergency specialty facility. I decline additional care above and beyond that provided by Animal Hospital of Shawnee Hills. Release of Legal Liability Regardless if whether I consent or decline to having medical intervention or CPR performed on my pet, in consideration for the following directive, I hereby waive, release and discharge any and all claims for damages, including, but not limited to claims for death, injury or property damage, whether or not resulting from the negligence, gross negligence, misconduct or other acts of Animal Hospital of Shawnee Hills, its veterinarians and staff, that I may have individually or on behalf of my pet, or that may subsequently accrue, as a result of honoring this directive, and I declare that any such veterinarian, staff and the Animal Hospital of Shawnee Hills is acting in accordance with my directions. This is intended to be an advance release of legal liability, even if negligence or other misconduct occurs. I have been informed of the fees to pursue the course of treatment recommended for my pet will be in addition to the original estimate and I agree to pay these additional fees regardless of his/her survival. I have read the above information and release. I agree to the above terms and have made my choices for medical care on my pet above. Pet Owner Signature: Pet Name: Best Contact Phone Number in the Event of an Emergency: Witness Signature: Today s Date: Breed:

MEDICATION 2 MEDICATION 1 Thank you for choosing Animal Hospital of Shawnee Hills for your pet s care! Please complete a section for each medication, supplement, or medicinal treatment. Be as specific as possible and provide all information to ensure the best care for your pet. We want your pet to feel like they are at home! Upon boarding admission, bring all medication and supplements in the original container. Include only enough for the length of your pet s stay at AHSH. Please note there may be an additional charge for the administration of some medications and treatments. Any pet receiving injections more than once during their stay will be boarded in our medical suite in the upper level under the supervision of a veterinary technician (additional care and charges will apply). Medication/Supplement Intake Form Pet Owner Name: Pet Name, Breed/Type: Arrival Date Departure Date Yes No Type of Medication/Supplement: Capsule Tablet Chew Ointment Drops Spray Powder Injection, Injection site: Other: Timeframe of Administration: 7-9 AM 1-3 PM 3-5 PM 9-10 PM Other: Best administered by the following method: Eats it as treat, it tastes great! Orally (pill popper needed) In a meal (just toss it in!) In a snack (hide it in a pill pocket) Peanut Butter Cheese Canned food (rolled into a ball) Other: Yes No Type of Medication/Supplement: Capsule Tablet Chew Ointment Drops Spray Powder Injection, Injection site: Other: Timeframe of Administration: 7-9 AM 1-3 PM 3-5 PM 9-10 PM Other: Best administered by the following method: Eats it as treat, it tastes great! Orally (pill popper needed) In a meal (just toss it in!) In a snack (hide it in a pill pocket) Peanut Butter Cheese Canned food (rolled into a ball) Other: Animal Hospital of Shawnee Hills 9540 Dublin Road Powell, OH 43065 info@shawneehillsvet.com www.shawneehillsvet.com (PH) 614.389.6455

MEDICATION 5 MEDICATION 4 MEDICATION 3 Yes No Type of Medication/Supplement: Capsule Tablet Chew Ointment Drops Spray Powder Injection, Injection site: Other: Timeframe of Administration: 7-9 AM 1-3 PM 3-5 PM 9-10 PM Other: Best administered by the following method: Eats it as treat, it tastes great! Orally (pill popper needed) In a meal (just toss it in!) In a snack (hide it in a pill pocket) Peanut Butter Cheese Canned food (rolled into a ball) Other: Yes No Type of Medication/Supplement: Capsule Tablet Chew Ointment Drops Spray Powder Injection, Injection site: Other: Timeframe of Administration: 7-9 AM 1-3 PM 3-5 PM 9-10 PM Other: Best administered by the following method: Eats it as treat, it tastes great! Orally (pill popper needed) In a meal (just toss it in!) In a snack (hide it in a pill pocket) Peanut Butter Cheese Canned food (rolled into a ball) Other: Yes No Type of Medication/Supplement: Capsule Tablet Chew Ointment Drops Spray Powder Injection, Injection site: Other: Timeframe of Administration: 7-9 AM 1-3 PM 3-5 PM 9-10 PM Other: Best administered by the following method: Eats it as treat, it tastes great! Orally (pill popper needed) In a meal (just toss it in!) In a snack (hide it in a pill pocket) Peanut Butter Cheese Canned food (rolled into a ball) Other: