Aqueduct Animal Hospital

2721 Balltown Road
Schenectady, NY 12309

(518)346-3467

aqueductah.com

Boarding Consent Form Form

First/Last Name

Pet's Name

Q1 Response
I agree to pay for all services due by the date of checkout or my pet/s will not be released from Aqueduct Animal Hospital (AAH).
Q2 Response
I agree that by signing this contract and leaving my pet with AAH, I certify the accuracy of all information given about my pets.
Q3 Response
I agree I understand that my pet must be picked up by 11:00 am, (check out time). If I pick up my pet after check out time, I will be charged an additional full day of boarding. Check-in time is 2:00 pm Monday through Friday and 10:00 am on Saturday. I understand that if I drop my pet off prior to check in time, I will agree to pay a $20 early check-in fee.
Q4 Response
I agree AAH is not responsible for lost or damaged toys or belongings brought into our facility. Customers may choose to bring in items at their own risk.
Q5 Response
I understand that my pet(s) must by current on their vaccinations prior to staying at AAH. We require DAPPV, Rabies, and Bordatella vaccines for dogs, and FVRCP and Rabies vaccines for cats. Although we can vaccinate your pets during their stay, they may not be covered against the diseases in which we are vaccinating against for 7-14 DAYS. Therefore, if my pet contracts an illness related to overdue vaccines, I release AAH from all responsibility.
Q6 Please select one or the other:
My pet is currently on Heartworm prevention (Dogs only) and flea and tick prevention. -OR-
My pet is NOT up to date on these preventatives.
Q7 If your pet is not up to date on preventatives:
Please administer a flea and tick preventative.
Please administer Heartworm preventative.
Q8 Please select one of the following (fecal exam must be agreed to be paid for):
My pet has had a negative fecal exam within the past 6 month
My pet has not had a negative fecal exam within 6 months. Please collect a fecal sample while board
I agree to pay for this additional charge.
Q9 Response
I understand that my pet may have an upset stomach if he/she is fed a different food while boarding. I am welcome to bring my food in clearly labeled bags and that pets are fed twice daily. I understand that although AAH feeds a very high-quality prescription diet to their boarding pets that my pet may develop diarrhea and/or vomit due to this food change.
Q7 Response
I agree in case of minor stress related symptoms such as stomach upset, vomiting, loss of appetite, or minor scratches that the staff may administer the following over the counter remedies, Nutramaxx Proviable Forte, (for diarrhea), diphenhydramine, triple antibiotic cream, or Pepcid AC. The staff may administer a prescription bland diet as well. I agree to pay for all necessary fees related to administration.
Q8 Response
I understand that Aqueduct Animal Hospital will try to contact me if my pet becomes ill while boarding. I consent to have my pet examined and treated by Aqueduct Animal Hospital’s doctors and staff if they are unable to reach me or if my pet is experiencing a true emergency.
Q9 Please select one of the following:
Do anything for my pet’s health. This includes transfer to UVS -OR-
Please call me if diagnostics and treatment estimate over
Q10 Amount approved for treatment:

Q11
I understand that AAH will make every attempt to manage all sick cases at the hospital, BUT if it is after hours and a doctor is not available, we may need to transfer your dog to Upstate Veterinary Specialties. The fee for transportation is $45 each way. If an employee needs to stay with your pet, the cost $10/half hour. These fees will be added to your pet’s boarding bill.
Q12
I agree to pay $2.00 per administration of medications that are not eaten with my pet’s meals. This includes oral, eye, ear, injectable and topical medications.
Q13
I agree if my pet is staying longer than 7 days, AAH will bathe my pet the day before he/she leaves the kennel for free at your discretion. I understand that most baths and grooms are done prior to my return and that the staff does their best to keep every dog as clean as possible in the kennel. I understand that if I want my pet to be groomed by the stylist, additional fees may apply. I will inform AAH if I would like my pet groomed during check in.
Q14
I agree to release Aqueduct Animal Hospital and its agents and employees from any and all liabilities or claim due to injury to myself, my pet, or any other property of mine, which may arise in any way out of services and/or products provided by or as a consequence of my association with Aqueduct Animal Hospital. AAH is not liable if my pet causes injury to him/herself and is not liable for stress related illness that they are not in control of. If I choose to board more than one of my pets in the same enclosure, I release AAH of all liability in the event that one pet causes injury to another. I understand that boarding can be stressful, and my pets may act differently in this environment than they do in their home, to the point of causing a fight between themselves.
Q15
I agree to pay for all services due by the date of checkout or my pet/s will not be released from Aqueduct Animal Hospital (AAH).

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