Important

This form WILL NOT automatically schedule your dates in our system. YOU MUST call to verify we have set up your dates.

Vaccine Requirements to board at BVH

Pets must be current on required vaccines: 1-Rabies 2-Bordatella 3-Distemper 4-Parvo virus 5-Leptospirosis 6-H3N2/H3N8 Influenza Combo (optional but strongly recommended) **7-Negative fecal (internal parasites)

Please initial that you agree to our vaccine policy requirements. If your pet is not up to date we can vaccinate (additional fees will apply) while pet(s) are boarding with us.

I Agree*

Yes
No

Owner/Pet information

Phone*

The number we use to reach you while your pet is with us.

Time Zone

When we have to call you, it's nice to know if we need to consider time zones. There is a tiny difference between calling in Texas vs calling China. So just a general idea of your time zone is very helpful.

*

Owner's Name*

First Last

Pet's Name*

ONE PET PER FORM.

Drop-off Date*

Drop-off Time (HH:MM AM/PM)*

Drop off and pickup times are 8-9:30 am and 3:30 to 5 Mon-Fri, Saturday is 8-12pm. Sunday the clinic is closed.

Has the pet been fed?*

Yes
No

Depending on time of drop off, let us know if breakfast/lunch or dinner needs to be given.

Pick-up Date*

Pick-up Time (HH:MM AM/PM)*

Drop off and pickup times are 8-9:30 am and 3:30 to 5 Mon-Fri, Saturday is 8-12pm. Sunday the clinic is closed.

Contact Number*

Email*

Husband/Wife/Partner Contact*

This person has authorization to make decisions if needed. If not type "None"

Secondary Contact Number

Significant other or if you have more than one number you would like us to use to reach you by.

Authorized to pick-up pet*

Is there another person(s) authorized to pick-up your pet? If not type "NONE".

Muti-Pets - Please choose ONE of the below.*

Pets to board together
Board together but feed seperately
Board separately
Only one pet

Has your pet experienced any coughing, sneezing, vomiting or diarrhea in the past 10 days prior to drop-off?*

No
Yes

If YES please explain:*

Food & Medications

Pet's food.*

Food from home
Food supplied by BVH

Type of food*

Dry
Canned ($2.00 per can of clinic food)
Mix of wet/dry
Other

If "Other" please explain feeding regimen.

Amount of food for AM feeding.*

Amount of food for PM feeding.*

All medications must be in original containers with pharmacy labels. No daily pill containers, individual pill packets or medications in baggies will be accepted. There is an additional fee per night for dispensing of medication

Medication list

Medication Name	AM dose	PM dose

List all medications you pet is taking. Use the + to add more

Will medications be given prior to drop off?

No
Yes

If yes, what time will they be given? (HH:MM - AM/PM)

During your pets stay with us would you like any of the following services for an additional fee?*

Please note, BVH is flea free. If fleas are found treatment will be performed at your expense.

Buttercup Veterinary Hospital

To be known as “BVH” in the below policy

• All pet(s) must be healthy, and current on all vaccinations. Vaccines required by BVH are:
Rabies
Distemper
Para-influenza
Parvo
Leptospirosis
Influenza H3N2 strain
Bordetella.
Vaccines must be administered by a Veterinarian. A copy of your pet(s) updated vaccination records from your vet is required prior to starting daycare or board with us to ensure your pet(s) safety as well as that of our other guests. These requirements also include the Bordetella vaccine for dogs, and an Intestinal Parasite Screen with negative results that has been done in the past year for all pet(s).

• Dogs/cats with fleas or ticks will be treated at the owner’s expense.

• Boarding fees are based on per night, and additional fees will be assessed for administration of medications. The boarding check- in/out hours are Mon-Fri. 8:00a-6:00p and Saturdays 8:00a-1:00p.
*BVH is closed on Sundays to the public and boarding check-ins/outs is not available.*

• BVH uses Purina EN (Gastrointestinal Chicken/Rice). Although Purina EN decreases the risk of gastrointestinal issues; abrupt change in diet may cause upset stomach and/or diarrhea. If your pet is on a special diet, please bring their food with them with a sufficient quantity for the duration of their stay. In the Cattery we use Pro Plan Salmon and Rice.

• Owners are welcome to bring their own blankets, beds or toys; however we cannot guarantee that these items will be returned in the same condition or at all.

• For safety and liability reasons, we do not board pet(s) that may have contagious infections or who may be too aggressive for our staff to handle safely.
• If a pet(s) becomes ill or otherwise requires medical attention, BVH will use contact numbers provided by you on this boarding form, if BVH is unable to reach you, we will treat your pet(s) accordingly, and you will be responsible for all charges.

• If there is a life threatening situation, and we are unable to reach you or your emergency contact, then the attending Veterinarian will make the necessary decision(s) based on what is best for your pet(s). This may include being transferred to an Emergency/Specialty Hospital or regrettably, euthanasia. You will be responsible for all charges incurred at the referral hospital.

• Owner is aware that by leaving pet(s) at BVH, or any other pet facility, the pet(s) is at risk of being exposed to contagious diseases. BVH maintains a high standard of cleanliness and safety for your pet(s), and does everything possible to minimize risk.

I understand that I am solely responsible for any harm or damage caused by my pet(s) to persons or property of the Owners, and employees of Buttercup Veterinary Hospital, or any other pets housed or visiting Buttercup Veterinary Hospital while my pet(s) is/are attending our boarding facility.
You release, indemnify, and agree to BVH harmless from any and all manner of damages, claims, loss, liabilities, costs or expenses, causes of actions or suits, whatsoever in law or equity, (including, without limitation, attorney’s fees and related costs) arising out of or related to the services provided by BVH. Owner also authorizes the release of said pet’s medical records from pet’s veterinarian.

Signature*

By signing above you acknowledge that you have read and agree to the BVH boarding policy.

1. Electronic Signature Agreement. By typing in your name,you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By signing you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide Buttercup Veterinary Hospital, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and Buttercup Veterinary Hospital. You further agree that each use of your E-Signature in obtaining a Buttercup Veterinary Hospital service constitutes your agreement to be bound by the terms and conditions of the Buttercup Veterinary Hospital Disclosures and Agreements as they exist on the date of your E-Signature.

Boarding Admission Form (Step 2)

Important

Vaccine Requirements to board at BVH

Pets must be current on required vaccines: 1-Rabies 2-Bordatella 3-Distemper 4-Parvo virus 5-Leptospirosis 6-H3N2/H3N8 Influenza Combo (optional but strongly recommended) **7-Negative fecal (internal parasites)

Owner/Pet information

Time Zone

Food & Medications

Buttercup Veterinary Hospital

Contact Us

Hours of Operation

Emergency Care

Online Pharmacy

Boarding Admission Form (Step 2)

***Important***

Vaccine Requirements to board at BVH

Pets must be current on required vaccines: ** 1-Rabies ** 2-Bordatella ** 3-Distemper ** 4-Parvo virus ** 5-Leptospirosis **6-H3N2/H3N8 Influenza Combo (optional but strongly recommended) **7-Negative fecal (internal parasites)

Owner/Pet information

Time Zone

Food & Medications

Buttercup Veterinary Hospital

Contact Us

Hours of Operation

Emergency Care

Online Pharmacy

Important

Pets must be current on required vaccines: 1-Rabies 2-Bordatella 3-Distemper 4-Parvo virus 5-Leptospirosis 6-H3N2/H3N8 Influenza Combo (optional but strongly recommended) **7-Negative fecal (internal parasites)