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Boarding Release Form - Powell Animal Hospital - Powell, TN

Powell Animal Hospital

205 Star Mountain Way (Formerly500 W Emory Rd)
Powell, TN 37849

(865)938-1884

powellanimalhospital.com

Boarding Release

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone (required)
Phone TypePhone Number (required)
Phone
Phone TypePhone Number
E-Mail Address (required) :
Pet's Name(s) (required)

Emergency Number Where Someone Can Be Reached (required)

What dates will your pet be staying? (mm/dd/yyyy)

If your pet is staying more than 3 nights, would you like a half-price bath before pick-up?

Yes.
No.


If your pet is staying more than 6 nights, he/she will be bathed for free prior to departure.
Would you like your pet to have a supervised play time in our fenced in yard for $8.10 per session?

Yes - 2 sessions per day.
Yes - 1 session per day.
No.


Are there any additional services that you request for your pet while boarding?

Please list any abnormalities that your pet has shown recently (i.e. coughing, sneezing, vomiting) (required)

Does your pet have any special needs that need to be taken care of while boarding? (required)

Please list any food or belongings that you intent to leave with your pet: (required)

Please list any medications that your pet is taking and any instructions for administration: (required)

Boarding Policy:
In order to board at our facility, your pet must be up to date on the following vaccines and wellness services: Rabies vaccine, Distemper vaccine (DA2PPV), Bordetella vaccine, Fecal Ova and Parasites test, Heartworm test, and Wellness exam.
If your pet has vaccine and wellness records at another hospital, please list the name below.

Authorization:
In case of emergency illness or injury, I do hereby give my consent for the doctors of Powell Animal Hospital to treat, prescribe for, or operate upon my pet(s) while they are being boarded at Powell Animal Hospital in the case that I cannot be reached. Any pet found to have fleas will be treated with a Capstar to keep our kennel flea free. They are to use all reasonable precautions against illness, injury, or escape of my pet(s), but they will not be held liable or responsible in any manner whatsoever, under any circumstances, on account of the care, treatment, or safe-keeping of my pet(s), as it is thoroughly understool that I assume all risks. Should the circumstance arise that my pet(s) remain unclaimed after the date which I have state as the pick-up date, I understand that written notice be mailed to the address above. Seven days after such written notice, the pet(s) will be considered abandoned and will become the property of Powell Animal Hospital to be disposed of as we deem best. It is further understood that such action will not relieve me from paying all costs of your service and the use of your hospital, including the cost of the boarding service.
I have read the above and - (required)

I agree.
I disagree.



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