BridgeMill Animal Hospital

9560 Bells Ferry Road
Canton, GA 30114

(770)479-2200

bridgemillvet.com

BridgeMill Animal Hospital

9560 Bells Ferry Rd

Canton, GA 30114

Phone: 770-479-2200  Fax:  770-479-2210

Boarding Release Form

Please make sure to check the caption box and click on the submit form box when submitting online. To keep all of our patients protected proof of current vaccinations including the flu vaccine must be presented when pets are being admitted. If proof is not provided the required vaccinations will be given and charged to your invoice. You also have the option to print out the form and manually filling it in to bring with you to the clinic. CLICK HERE FOR THE BOARDING FORM.

Online Boarding Form

Date :
Client ID #

Owner's Information (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)
Emergency Contact (In the event that owner cannot be reached) (required)
First Name (required)
Last Name (required)
Emergency Contact Number (required)
Phone TypePhone Number (required)
Pet's Name (required)

Species (required)

Breed (required)

Estimated Age (required)

Sex (required)

M
F


Color (required)

BOARDING INFORMATION
Boarding Date

Date of pick up, please specify time of pick up: (ex:09/23/2018 at 8:00 pm)

Person picking up pet if other than owner

Bath (required)

Yes
No


Medication? (required)

Yes
No


Scheduled Grooming? (required)

Yes
No


Nail Trim Only (required)

Yes
No


Personal Items Left (Check all that apply)
Bed
Toy(s)
Food
Bowls
Carrier
Other
If Other, please specify

Feeding (required)
AM
PM
Quantity each feed (required)

Preferred Diet (required)
Hospital Food
Brought from home
Extra Play Time ($6.00 each)

Once Daily
Twice Daily
Other


Puppy Pops (Frozen Dog Treats) ($1.00 each)

Once Daily
Twice Daily
Other


Special Instructions/Other Requests-include detailed medication, feeding instructions, and anything you wish the doctor to check

VACCINATION/EXTERNAL PARASITE POLICY

MEDICAL ILLNESS POLICY

***Please read the statement above before proceeding*** (Please initial emergency directive below:)
Please perform whatever services the doctor deems necessary for the best care for my pet until someone can be reached by telephone. This includes only non-elective treatments and necessary diagnostic testing. (required)

I authorize up to:
Circle one (required)

$100
$200
Other $


For Other $, please specify

Initial here for the above statement (required)

Do not administer any medical treatment until specific authorization is given. Please type N/A if this is not your choice. (required)

We are not liable for any lost items such as toys, bedding, blankets, etc.
I have read and understand this agreement. I fully intend to pick up my pet(s) on the above specified date and pay in full at that time. If circumstances change, I will notify BridgeMill Animal Hospital of a new pick-up date.
Signature (required)

Date (required) :

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