Boarding and Medical Intervention Release Boarding and Medical Intervention Release Please fill out the form below, and a member of our team will get back to you shortly. If you have any questions, please feel free to contact us. Please Note: Any fields with * are required. What diet are you currently feeding? If you have multiple pets, please list all their diets here. * How much and often are you feeding your pet(s)? * If your pet is currently taking medication, please list all medications and how often they are to be given. * Below, you will find a Medical Intervention Release form. If you have filled this out recently, you may skip this part If you have not filled this out before or would like to make updates, please do so at this time. This is a boarding requirement. Lastly, if you have multiple pets and the same applies to all, please list all their names. If the same answers do not apply to all, please specify in your comments. Medical Intervention Release Name * Name First Name First Name Last Name Last Name Pet Name * Email Phone Would you like to opt in to receive text messages from Case Veterinary Hospital? * Yes No It is our pleasure to spend time with your loved ones while you are away from home and thank you for trusting us to care for your family. If medical intervention becomes necessary during your pets’ stay with us, every attempt will be made to contact you at the emergency number you have provided. However, if we cannot reach you, we respectfully request that you provide us with the following instructions: Do you authorize an examination and treatment to be performed at Case Veterinary Hospital? * Yes No If an examination and treatment is authorized, what amount would you not want us to exceed? In the event of a critical emergency, do you authorize transfer to Savannah Veterinary Emergency Clinic (SVEC)? * Yes No If you have entered yes, you agree to be financially responsible for all treatment and services they perform. SVEC is not affiliated with Case Veterinary Hospital, and Case Veterinary Hospital is not responsible for payment. Should your pet require life-saving measures, such as Cardiopulmonary Resuscitation (CPR), would you like for the Case Vet team to resuscitate or do you prefer that we do not resuscitate? * Yes No *CPR authorization includes associated fees. Do you decline any interventional care and associated costs? * Yes No If you are declining, would you like to discuss alternative options for boarding? Yes No Not Applicable Social Media My pet’s picture may be used on Case Veterinary Hospital’s website, Facebook, Instagram or any media site that suits the Hospital. I can withdraw my consent at any time I will receive no compensation for my consent I understand pictures may be copied and used by Case Veterinary Hospital without further permission. The original copy of this consent form will be kept in my records. Do you consent? * Yes No Signature * signature keyboard Clear Captcha Submit If you are human, leave this field blank.
