Your Cat(s)' Name(s) (required) May we use the number above to text you information about your pet? yes no May we use the number above to text you information about your pet? yes no May we use the number above to text you information about your pet? yes no E-Mail Address :
Tentative Boarding Dates:
Dates Boarding: (required) Location Desired (call to check availability):
Is your cat currently taking any medication? (please bring all medication with your cat) yes no If yes, please list the medication and how often it is given: Every attempt is made to medicate your cat; but, if a boarder is aggressive, we may not be able to.
Food: Cats must be on the same diet if they are housed together (in the Paris or Hawaii Suites
Did you bring your cat's food with him/her? (If not, there is a food charge of $3.24 per day per cat for Science Diet Sensitive Stomach) yes no If yes, what type and how often do you normally feed your cat per day? If not, how often do you normally feed your cat?
Personal Belongings: (please list and describe any other items brought with your animal)
Treats Bedding Toys Other Please read: Please note that any and all items left in our care will be treated properly but we cannot be held responsible for loss or damage that may occur to your pet's belongings during their stay at HCH. Please initial here if you are leaving any belongings:
Are there any other services you would like performed during your cat's stay?
I understand by checking these boxes I am initialing additional procedures at additional cost. (required) Please complete a urinalysis. (Recommended if >6 yr) Please radiograph my pet's chest to detect possible heart/lung disease. (Recommended if>6yr) Please scan my pet, if no microchip is found, please permanently identify with a microchip. Please trim my pet's nails if indicated. Please clean my pet's ears if indicated. Please update my cat's Vaccines. If needed, which vaccines would you like us to give your cat? Rabies Vaccine Feline upper respiratory(HCP) Feline Leukemia (FeLv) all all but Feline Leukemia
Has your pet shown any recent signs of: Vomiting Diarrhea Sneezing Coughing Please explain (frequency, discharge, etc): Is there anything else that you would like addressed by HCH while your pet is staying with us?
In the event that my companion animal arrests while staying at Hebron Cat Hospital
I authorize the following CPR code: (required) (by checking the box you are initialing your choice) CPR: Normal CPR involving chest compressions, oxygen
therapy and medications such as epinephrine, atropine, etc. DNR: No resuscitation Please Read Carefully In case of illness or injury, I, the undersigned do hereby give my consent for Deanne Durham, DVM,
her agents, servants, and/or representatives to treat, prescribe for, or operate upon my pet(s) while they
are being boarded at Hebron Cat Hospital. You are to use all reasonable precautions against illness,
injury, or escape of my pet, but you will not be held liable or responsible in any manner whatsoever, or
any circumstances, on account of the care, treatment, or safe keeping of my pet, as it is thoroughly
understood that I assume all risks. Should the circumstance arise that my pet remains unclaimed after
the date which I have stated as the pick-up date, I understand that written notice will be mailed to the
address on file. Seven days after such written notice the pet will be considered abandoned and may be
disposed of, or destroyed as HCH deems best. It is further understood that such action will not relieve
the undersigned from paying all costs of our services and the use of our hospital, including the cost of
the boarding service. I understand that if my pet is not up to date on annual vaccines, they will be given
and I will be responsible for the payment of these services. Highly aggressive cats, will have an additional fee of $10 added to their daily boarding. I understand that if any fleas are found on my cat, I will be charged for flea medication. By initialing below I am giving my approval to the above statements. (required)