Boarding Diabetic Instruction Form

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Boarding Diabetes Instructions

For a timely check-in, please complete prior to arrival. Thank you!

Name *

First

Last

Email *

Pet's Name *

First

Last

Arrival Date *

Departure Date *

All medications must be brought to boarding in original prescription packaging supplied by your pet's veterinarian. Feline = additional $14/day Canine = additional $18/day

Insulin Instructions for a.m. and p.m.

Number of units for a.m. and p.m.

Date/time last given in a.m. and p.m.

Time your pet is fed in a.m. and p.m.

Amount of food given in a.m. and p.m.

Date/time last fed in a.m. and p.m.

WE REQUIRE YOU TO BRING YOUR PET'S OWN BOTTLE OF INSULIN, INSULIN SYRINGES, AND REGULAR FOOD WITH ENOUGH FOR THE ENTIRE STAY. All canine diabetic boarders receive a minimum of 4 walks per day during their stay.

Diabetic Boarding Authorization for Treatment: I understand that diabetes is a complicated disorder requiring a delicate balancing of food intake, amount of exercise, insulin given, and other factors. Because of this, a diabetic animal may require urine and/or blood testing while boarding. I authorize the staff at Pittsford Animal Hospital to perform tests if necessary for my pet's well-being.

Signature *

Phone *

Name of emergency contact *

First

Last

Emergency contact phone number *