Boarding Consent Form

    Thank you for choosing Ness Exotic Wellness Clinic. In order to personalize your experience and have a clear client profile, we need you to fill out our Boarding Consent Form below. Your data is safe with us.

    Today's date

    Client Address

    Boarding START Date:

    Boarding END Date:

    PATIENT INFORMATION

    Patient Date of Birth

    Gender

    Neutered/Spayed

    Allergies

    REQUIRED Avian Procedures/Testing (please provide most recent dates)

    Standard Exam Date
    (within 6 months)

    Avian Chemistry Profile
    (within 1 year)

    Avian CBC
    (within 1 year)

    Bile Acid
    (within 1 year)

    Chlamydophila: DNA PCR Swab or AB Titer
    (within 2 years)

    REQUIRED Mammal Procedures/Testing (please provide most recent dates)

    Standard Exam Date
    (within 6 months)

    Mammal Chemistry Profile
    (within 1 year)

    Mammal CBC
    (within 1 year)

    Ferrets ONLY :: Rabies Vaccination and/or Rabies Vaccination Titer

    Ferrets ONLY :: Distemper Vaccination and/or Distemper Vaccination Titer

    Digital Signature

    I hereby give consent to Ness Exotic Wellness Center to provide boarding services for my pet(s) from the dates indicated above. I understand that unforeseen conditions may require a medical or surgical procedure, immediate resuscitation, and/or treatments. I understand that I assume all risks and associated costs. If I am unable to be reached at the contact information I have listed above, I hereby authorize the performance of such procedures as necessary, and advisable for the welfare of my pet in the professional judgment of the veterinarians on staff at Ness Exotic Wellness Center.

    Data Privacy and Consent:

    I agree to the terms of service

    REQUIRED Reptile Procedures/Testing (please provide most recent dates)

    Standard Exam Date
    (within 6 months)

    Reptile Chemistry Profile
    (within 1 year)

    Reptile CBC
    (within 1 year)

    Fecal Exam – Direct Smear & Float
    (within 1 year)

    INNER OFFICE USE ONLY


    Exemption(s) of _________________________ services and/or testing as approved by Dr. _________________ on the date of ______________, due to ____________________________.