ADMITTING APPOINTMENT:______________________
MEDICAL BOARDING FORM
With doctor’s orders, AHNA will provide medical boarding to our patients if they are
on medication that is not easily administered or if a medical condition necessitates
special care or if they are so frail that standard boarding would not be appropriate.
PLEASE COMPLETE THIS FORM PRIOR TO ARRIVAL
Owner’s Name: __________________________________________
Pet’s Name: _________________________
Record # ___________
Regular Home Phone # : __________________
What brand of food do you feed?: (please be exact i.e. Purina Senior): ____________________
When do you feed one two all day (circle) times daily? Time/Date of last meal:____________
How much at each meal? _______________________________________________________
Avoiding a change in diet is best. What food are you bringing?___________________________
If you do not bring food, you may purchase Science Diet when you arrive. Please clearly mark
all items that you bring with your pet’s name (including toys, bedding, food, etc.).
MEDICATIONS
TIME(S) ADMINISTERED EACH DAY
WHEN LAST GIVEN
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
In case of an emergency, we would like to be able to reach you personally, but if that is
impossible, we MUST have a number of someone local, who has authority to make life or death
decisions regarding your pet, should the need arise.
Number where you can be reached: _____________________________________________
Name and Phone #s of local contact person(s): ____________________________________
____________________________________________________________________________
Date and Time Admitted:________________________________________________________
Anticipated Pick Up Date and Time: ______________________________________________
PLEASE CIRCLE THE DOCTOR YOU WANT AS ATTENDING DOCTOR DURING THIS STAY
David Thompson, D.V.M.
Warren Riggle, D.V.M.
Paul Duncan, D.V.M. Susan Wootten, D.V.M
Amy Plankenhorn, D.V.M.
James Earley, D.V.M.
Dennis Golden, D.V.M, DACVIM Caroline Kiss, D.V.M, DABVP
I authorize the Animal Hospital of North Asheville, Inc. to provide any care deemed necessary
should my pet become ill while boarding at the hospital. I understand that the staff will attempt
to reach me or the above listed contact person(s) for authorization prior to treatment.
Signed: _____________________________________________ Date:__________________
Please feel free to include additional information on the back of this form.
Please Keep This Information With You
During Your Trip
The Animal Hospital of North Asheville wants your pet to be comfortable and healthy while you
are away. A doctor is responsible for the care of our hospitalized patients 365 days a year.
This is not just a boarding experience for your pet. Our trained staff will give your pet the same
level of care that is given to our hospitalized patients. Therefore, we can offer this service only
to those who truly need this degree of care and who are not disruptive to our other hospitalized
patients.
We realize that most people leaving their pet for boarding before a trip are in a hurry. However,
it is absolutely necessary for you to participate in the admitting appointment so that we can have
complete, accurate and up to date information on your pet. Please plan for the process of
admitting your pet to take at least twenty minutes.
If you are picking your pet up during our regular “after hours” times (weekdays after 5:30PM or
weekends), please realize that the staff is limited and must deal with emergencies before
discharging a patient. Your patience is appreciated.
We know that being apart from your pet is difficult for both of you. Please feel free to call “just to
check” if you are worried, but rest assured, we will try to contact you immediately if problems
arise. When you call, please give the receptionist your name and your pet’s name and inform
her that your pet is boarding, and she will route your call to a technician for information.
Our telephone number is 828-253-3393. If you are calling on the weekend, we answer the
phone on Saturday’s from 8AM until 12:00 PM. During the week, it is answered until 8:30PM;
however, the nurse will be working to provide care for our patients throughout the night.
We would like to discharge your pet during our regular office hours. Our office hours are:
Monday - Friday 7:30 AM to 8:30 PM,
Tuesday we close for staff training from noon to 2:30 PM,
Saturday 8:00 AM to 12:00 PM (Noon) and 4:00 PM,
Sunday at 4:00 PM.
FEES: In order to be able to provide this level of care, the following charges apply:
Admit Patient…………………………………..……………………….………. $39.01
Hospitalization (per 24 hour period)…dogs less than 50 lbs………..…….. $44.02
dogs greater than 50 lbs………….. $56.51
cats in heated condominiums…….. $44.02
Diabetic Patients (with all supplies provided by owner)...Injection(s)..……. included
Blood Glucose Tests……………………………………………………………. $29.85 ea
Oral Medications Administered (if patient is cooperative)…………………… included
Any Other Tests or Medications Administered At Normal Hospital Fees….