Stream Valley Veterinary Hospital

42902 Waxpool Road
Ashburn, VA 20148-4525

(703)723-1017

www.streamvalleyvet.com

Boarding Admission Form

To expedite your pet's check-in for boarding, we recommend that you fill out the below Boarding Admission Form to submit at least 24 hours prior to drop off.  (You may also download and print a hard copy version of the form if that is more convenient for you).  Please be sure to contact us to schedule your reservation prior to completing this form.

Should you choose to complete the form in person at the time of drop off, we ask that you please allow at least 10 minutes for the paperwork.  Please be aware that at boarding check-in, we will also verify vaccination and preventive care (see our Protocols), schedule any desired bathing or grooming, and take note of any other special requests you may have.  Therefore, so that you can plan your travels accordingly, it is best to allow several minutes for boarding check-in.

If you have any questions, if you need assistance with this form, or if you'd like to schedule your pet's boarding stay, we can be reached at (703) 723-1017 or via your Pet Portal.

Thank you!

Online Boarding Form

Client and Pet Information
Client Name (required)
First Name (required)
Last Name (required)
Emergency Contact - Name (required)
First Name (required)
Last Name (required)
Emergency Contact - Number (required)
Phone TypePhone Number (required)
Additional Emergency Contact Number
Phone TypePhone Number
Dates of Visit (required)

Estimated Pickup Time (required)

Pet Name (required)

Pet Species & Breed (required)

Sex (required)

Color (required)

Fees Per Calendar Night
Based on Species and Weight
Note: "client" refers to those who pursue regular, routine veterinary care at Stream Valley Veterinary Hospital; "non client" refers to those who may pursue grooming, boarding, or daycare at Stream Valley Veterinary Hospital, but NOT regular, routine veterinary care.
Cats
$27 per night - client / $32 per night - non client
Small Dogs (<30 pounds)
$32 per night - client / $37 per night - non client
Medium Dogs (31-60 pounds)
$34 per night - client / $39 per night - non client
Large Dogs (>60 pounds)
$36 per night - client / $41 per night - non client
Exotics and Pocket Pets
Please contact us for specific boarding and pricing information for pets other than cats and dogs.
Medication Administration Fees
Will your pet require medication during his/her stay? (required)
Yes
No


Fees per dose:
Medication administered once daily: courtesy. Medication administered twice daily: $5.25 per day in addition to above fees. Medication administered greater than twice daily: $8 per day in addition to above fees.
Medications - Complete this Section with Care
We believe every guest has the right to receive prescribed medications as directed by the doctor and owner. These medications will be administered under the direction of a doctor and licensed technician. They will be recorded in the patient's record and hospital treatment logs. Medications taken from hospital supply will be charged for, in addition to treatment fees above. All medications must be marked with a dispensing label by the prescribing veterinarian, or in the case of nutraceuticals (vitamins, joint supplements, etc.) be presented in the manufacturer's labeled container; if any medications or supplements are unmarked, we reserve the right to forgo their administration altogether, or replace them with a prescription dispensed from our hospital pharmacy. Please provide your pet's medication regimen below:
Medication Name

Dose/Strength

Frequency (times/day)

Schedule (certain time of day)

Last Dose Given (date/time)

Source of Medication
Provided by client
Dispensed from Stream Valley pharmacy supply


Medication Name (2)

Dose/Strength

Frequency (times/day)

Schedule (certain time of day)

Last Dose Given (date/time)

Source of Medication
Provided by client
Dispensed from Stream Valley pharmacy supply


Please describe any additional medications and doses here:

Special Medical Needs Fees
Guests with Special Needs
We are happy to provide additional bedding, increased walks, specialized medication administration, increased medical team monitoring, and more for pets with special conditions and needs. Such care is given at a cost of $18 per day, in addition to above fees.
Please indicate the nature of any special needs:
Diabetes
Heart Disease
Epilepsy
Orthopedic
Other (specify below)
Specify other Special Needs:

Feeding Instructions
Select a diet for your pet's stay (no difference in fees): (required)
Client-provided food
Stream Valley Kennel food
How much and how often should we feed your pet? (required)

Additional Services
Please describe any other services you would like us to provide:

Would you like us to examine your pet? For what reason?

Note:
Any animal who is new to our facility will be given a pre-boarding exam at a cost of $42. Any pets requiring medical/preventive services should receive an estimate specifying the type and cost of accompanying examination.
Additional Information and Requirements
Current Vaccinations-
We believe every guest has the right to be protected from infectious and contagious diseases. All patients must have current vaccinations. If vaccines and tests are not on record and proof of same is not provided, these services will be performed at pet owner's expense (you should receive an estimate for these services). Please visit the "Protocols" link above for more information about required medical services.
Please select which services we should provide to your pet:
Rabies Vaccine
Distemper Vaccine
Bordetella Vaccine
Canine Influenza Vaccine
Heartworm Test
FELV/FIV Test
Fecal Exam
Parasites-
We believe every guest has the right to be free of external (fleas, ticks, and mites) and internal (worms) parasites. If your dog or cat is not on flea prevention, it will be administered during stay at pet owner's expense. If your pet has not had a Fecal Exam (negative result) or Heartworm Test (for dogs) within the last 12 months, we will test your pet at pet owner's expense. If your dog is not on heartworm prevention, we will test and provide prevention at pet owner's expense. If testing reveals infection, treatment will be prescribed as appropriate and you will incur additional fees.
Is your pet on flea prevention? (required)
Yes
No


Is your pet on heartworm prevention (required for dogs)? (required)
Yes
No


Would you like us to administer and/or dispense preventive? If so, what type?

Personal Items-
Every guest has the right to clean, comfortable housing. All leashes and collars should be removed. We cannot be responsible for items left with the pet.
Has your pet been known to chew up bedding? (required)
Yes
No


May we provide a blanket? (required)
Yes
No


Baths-
Every guest has the right to be clean during boarding stay. We will make every effort to keep pets clean; however, if they become soiled, they will be bathed at pet owner's expense. Every guest staying longer than five (5) nights will be required to have a bath before going home. You may request a kennel bath or grooming during your pet's stay.
Bathing Request (please double-check above est. pickup time):
Kennel Bath (with courtesy nail trim)
Professional Styling (recommended for all long-hair dogs; 15% off with boarding stay)


Emergency Services-
It is our responsibility to provide emergency treatment should the need arise. We will contact you (if possible) if the problem is serious; if a minor problem, we will treat according to the best interests of the patient. Fees for emergency services will be due at the time of check-out.
Please acknowledge that you have read and understand Emergency Policy (required)
I understand


Playtime-
You may request group playtime. Our kennel attendants may combine your pet with others of like temperament in attended playtimes.
I request and authorize group playtime for my pet: (required)
Yes
No


I understand that there is a risk of injury during playtime: (required)
I understand
Not applicable (no playtime)


Disclosure Statement-
This facility is NOT staffed 24 hours a day. Our medical staff is on the premises 6 days a week and kennel assistants 7 days a week. Any special care that is required after hours must be arranged ahead of time and will be administered by the veterinarian on call (please note in above "Special Medical Needs" section).
Please acknowledge that you have read and understand Disclosure Statement (required)
I understand


Payment-
I agree to pay for all services in full when my pet is released from the Hospital. Note: We will gladly provide an estimate upon request.
Please acknowledge that you have read and understand Payment Policy (required)
I understand


Cancellation Policy-
We require a $50 (per pet) deposit for all boarding reservations, which will then be applied to your invoice total at the end of the boarding stay. This deposit is refundable if you personally notify our reception team of your cancellation at least fourteen (14) days prior to the start of your reservation.
Please acknowledge that you have read and understand Cancellation Policy (required)
I understand


Delay Policy-
Please drop off or pick up pets at least 15 minutes prior to business closing. A delay fee may be applied if our staff is held past closing time.
Please acknowledge that you have read and understand Delay Policy (required)
I understand


Is there anything else that you would like us to know for your pet's stay?

Final Authorization
Pet Owner Acknowledgement:
I have read the above conditions; I understand and agree to them. If I neglect to pick up my pet within seven (7) days of the end date of my boarding reservation, Stream Valley Veterinary Hospital shall assume that my pet is abandoned and is hereby authorized to place the pet as deemed necessary. I understand that this does not release me from the incurred charges. By typing my name below, I give my electronic signature to authorize this Kennel Boarding Agreement.
Electronic Authorization "Signature" (required)


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