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Home
Updates Regarding COVID-19
Our Services
>
Internal Medicine
Dental Care
Diagnostic Medicine
Wellness Exams
Surgery
Grooming, Boarding & Day Care
Hospice & Euthanasia
Pharmacy & Pet Supplies
Office Visits
>
Wellness
>
Pet Care Plan
Flea, Tick & Heartworm
Behavioral Medicine
Exams
Vaccinations
House Calls
Emergency Care
Microchipping
Covid 19 - Pandemic
Our Staff
Doctors
Client Center
ONLINE STORE
Client Forms
>
Anesthetic Release Form
Boarding Release Form
Consent For Treatment
Drop Off Form
Euthanasia Consent Form
New Client Form
Helpful Pet Links
Petly
Downloads
Client Reviews
Contact
Boarding Information Form
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
All pets must be current on vaccinations in order to board at Cheyenne West Hospital
Is your pet current on vaccinations?
*
Yes
No
Do we have permission to vaccinate your pet?
*
Yes
No
All pets must have a negative fecal test with the past year.
Do we have your permission to test a fecal sample?
*
Yes
No
Did you bring any personal items for your pet?
*
Yes
No
List Personal Items
*
Which food will your pet be eating?
*
My own food brought from home
Food provided by Cheyenne West
If bringing food, what brand of food do you feed?
*
How much and how often would you like us to feed your pet?
*
Emergency Contact Name
*
Emergency Phone:
*
Pet's Name
*
Pet's Age
*
Pet's Gender
*
Intact Male
Intact Female
Neutered Male
Spayed Female
Pet's Breed
*
Pet's Color or Coat
*
Please list if your pet has any medical concerns
*
Is your pet currently on medications or supplements (prescription or over-the-counter)?
*
Yes
No
If yes, list medication name, strength, daily dosage, and when last given:
Example: Famotadine 20mg - Give 1 tablet twice daily.
Medications
*
PLEASE NOTE: ALL MEDICATIONS AND SUPPLEMENTS NEED TO BE IN THEIR ORIGINAL CONTAINER. MEDICATIONS NOT IN THEIR ORIGINAL CONTAINERS WILL NOT BE ACCEPTED.
We do offer baths to dogs while they are here. A bath is complimentary after four consecutive nights of boarding. We apologize, but we cannot accommodate complimentary baths around holiday boarding times.
Would you like us to give your pet a bath while they are here?
*
Yes
No
In case of an emergency, do we have your permission to treat?
*
Yes
No
If you refuse treatment, this may lead to serious health problems, or even death, in some cases.
Please call our office if you cannot pick-up your pet on the scheduled pick-up date. Space is limited and we cannot always accommodate extended stays. Failure to call will result in an additional $6.00 per pet per night charge.
I further understand that all boarding fees are per pet, not per cage.
I am the owner or agent for the pet(s) described above and I have the authority to execute this consent. I fully understand that I assume all risk while boarding my pet(s) . A hospital staff member has explained to me that the hospital is not staffed with personnel overnight. The hospital and staff will not be held liable for any problems that develop provided they have taken all reasonable care and precautions against injury, escape or death of my pet(s). This is to certify that I have been informed of and agree to the policies regarding boarding including vaccinations and all associated costs as the hospital staff has explained them to me. I am the owner or agent for the owner and I have the authority to execute this consent.
Comments or requests for the doctors
*
Submit