Heart of Ankeny Animal Hospital

701 Ordnance Rd.
Ankeny, IA 50023

(515)635-0095

www.heartofankeny.com

A boarding check-in form is required for all patients boarding at Heart of Ankeny Animal Hospital. To ensure efficiency at check-in we would appreciate you filling out this form in advance. Please review our policies here and then scroll down to complete form and submit online prior to your pet's stay.

PLEASE DON'T FORGET TO HIT THE "SUBMIT THE FORM" BUTTON AT THE BOTTOM OF THE PAGE!

Thank you!

Boarding Check-In Form

Today's Date (required) :
Boarding Drop-off & Pick-up Dates (required)

Client/Patient Information
Client name (required)

Email Address

Patient name(s) (required)

Feeding Instructions
Please feed my pet(s): (required)

kennel food
own food


At what times do you feed your pet? (required)

AM
NOON
PM
AM & PM
My pet free feeds


How much per feeding? (required)

Please list any treats brought for your pet, and instructions:

Please list any FOOD/TREAT ALLERGIES your pet has:

If your pet doesn't eat well while here with us, may we give wet food to stimulate appetite? (required)

YES
NO


Would your like your pet to receive a daily Kong treat? ($3.50 each day - DOGS only) (required)

YES
NO


Social Media
Can we use photos of your pet(s) on our business social media pages? (required)

YES
NO


Medications
Is your pet(s) on medications? (required)

YES
NO


If your pet is on medication(s), please THOROUGHLY list each medication name, dosage, and frequency. If these aren't listed, we can't guarantee your pet will receive their medication correctly. (required)

Belongings
Please list/describe your pet's belongings brought with them:

Parasite Prevention
Is your pet(s) current on flea/tick prevention? (required)

YES
NO


If you answered YES, please list the product your pet is currently using and when it was last given/applied.

If NO, check one below for us to administer (Required, at your expense):

Oral Bravecto chew (DOGS only), lasts 3 months (protects against fleas/ticks)
Topical Bravecto Plus (CATS only), lasts 2 months (protects against fleas/ticks/heartworm)
Seresto Collar, lasts 8 months (protects against fleas/ticks)
Vectra Flea Spray, lasts 5 days (protects against live fleas only)


Additional Services
Please select any additional services you would like done for your pet while here:

Nail trim
Nail trim with grinding
Anal gland expression
Bath w/ boarding, free for deluxe stays > 5 nights
Microchip Implantation


Emergency Protocols
In the event of an emergency (check one) : (required)

(Option 1) Treat my pet as needed. Do all diagnostic tests, treatments, and procedures necessary for the well-being of my pet. I accept full financial responsibility for all charges related to the treatment of my pet
(Option 2) Treat my pet as needed. Do all diagnostic tests, treatment, and procedures necessary for my pet not to exceed a certain dollar amount (entered below). I accept full financial responsibility for all charges related to the treatment of my pet.
(Option 3) DO NOT perform any diagnostic tests, treatments, or procedures on my pet until you reach me. **In the event of a life-threatening situation, I consent to supportive care being performed on my pet until I, or my emergency contact can be reached.


If you selected "Option 2" above, please enter the dollar amount to not exceed.

Emergency contact (required)

Emergency contact phone number *we will attempt to contact you first, if you cannot be reached we will call your emergency contact next* (required)

Additional Information
Any additional information you have for us regarding your pet, please write below:

By checking this box, I agree that I have reviewed and understand the most current Boarding and Daycare Policies listed on this website. I also confirm that the information I have provided above is accurate to the best of my knowledge

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