Boarding Form

Name: Northwest Animal Hospital
Address: 2024 S River Rd, Des Plaines, IL, 60018, United States
Telephone: 847-296-3112
Price range: $

Thank you for choosing Northwest Animal Hospital! Please fill out the form as completely and accurately as possible.

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Boarding Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 847-296-3112 for a faster response.

Thank you for taking a moment of your time to fill out this boarding agreement. Our goal is to provide a happy and healthy environment for our patients. In keeping with that, goal we require that all patients be current on their vaccinations (Rabies/Distemper/Bordatella/Yearly Fecal) and free of all external and internal parasites before staying with us. Please note that our fees are based on a daily rate.

Name *

First

Last

Email Address *

Phone Number *

Alternative Contact

Contact Phone Number *

Patient Name and Breed *

Patient Name and Breed

Arrival Date *

Departure Date *

Medicated Boarding *

No, my pet does not require any medication or special care.
Yes, my pet requires medication and/or special care, and I agree to pay any additional fees resulting from such.

If your pet(s) are on any medications and/or special diets, please list below and include the treatment schedule. If it is necessary for us to dispense supplies of any sort during your pet’s stay, you will be responsible for any corresponding fees. Please choose one of the following:

Special Diet

Please provide any special diet information. Please note that special feeding requirements may have an additional charge.

Services to Be Provided During This Stay

If you have any specific concerns regarding your pet’s health, or would like to have any procedures performed during your pet’s stay, please indicate so below.

Other Services to be Provided

List any other services you would like to be provided.

Medical Treatment * *

Please do not exceed $500 in an attempt to save my pet.
Please do not exceed $1000 in an attempt to save my pet.
Please do everything within NWAH limits to save my pet, no matter the cost.
DNR (Do Not Resuscitate).

If your pet develops any medical condition during their stay, we reserve the right to treat as necessary to prevent the spread of illnesses. If your pet experiences a life-threatening problem, we will make every attempt to contact you or any authorized agent listed on this form. If we are unable to contact you, we will proceed as the doctor on staff deems necessary. If you do not want us to perform life saving procedures for your pet, please initial the DNR, do not resuscitate, option below. I understand that all treatments will be my financial responsibility.

Bathing *

Yes, please bathe my pet. I understand that there will be a fee to bathe my pet ranging from $46-$62.50 depending on my pet’s size, coat length, and type of shampoo used.
No, do not bathe my pet unless it necessary.

Pickup Contact Name

If your pet is to be picked up by someone other than owner, arrangements regarding the bill must be made in advance. Name of person authorized to pick pet(s) up (if different than owner listed above):

Additional Terms of Boarding *

I have read and understand the statement below.

Revisions to Boarding
Northwest Animal Hospital will no longer be accepting any personal items such as toys, blankets, beds, etc. Due to the nature of housing animals, personal items are often inadvertently lost, discarded, or damaged and their return home is not guaranteed. Please do not leave any leashes or collars. During your pets stay only hospital issue and approved leashes will be used.

Aggressive Pet Boarding Protocol
For our purposes, we are defining “aggressive” as any patient that attempts to lunge and/or bite an individual or other animal with the probable intention of doing harm. We would encourage all owners of aggressive pets to find an alternative to boarding their pets in a boarding facility, such as leaving the pet at home with a caretaker or taking him or her with you. We understand that circumstances do not always allow for these solutions. If any patient is deemed aggressive at the time of boarding admission or anytime thereafter, he or she will be categorized as an “aggressive pet”. The fee to board such pets is double that of our normal boarding fees per day. The nature of such pets will not allow us to extend grooming procedures to them, and we will not guarantee the condition of these pets upon the owner’s return.

General Information
*We are not staffed 24 hours a day; therefore, your pet(s) will be unattended during non-business hours.
*All animals must be free of external parasites and internal parasites when admitted for boarding, or must be treated, at owner’s expense.
*All precautions will be taken to prevent injury, escape, or other life-threatening emergencies. We will not be held accountable for problems that develop, provided that reasonable care and precautionary measures have been taken.

By signing below, you agree and understand the policies listed and you authorize Northwest Animal Hospital to care for your pet during their stay with us. You accept all financial responsibility for any and all charges incurred during your pet’s stay.

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