Boarding Authorization Form - Randhurst Animal Hospital

Randhurst Animal Hospital

212 East Rand Rd.,

Mt. Prospect, IL 60056

Call Us

847-398-5800

Request an Appointment

Mon - Fri: 8am • 7pm | Sat: 9am • 2pm

Client Name:*
First Last
Pet Name:*
Client Phone:*
Client Email:*
Emergency Contact Name:*
First Last
Emergency Contact Phone:*
Vaccine Statement - All pets must be current on the following vaccines: rabies, distemper and bordetella (kennel cough). Due to the documented failure of mail order or store bought vaccines, only vaccines administered by a licensed veterinarian will be acceptable. If vaccines are not current or not administered by a licensed veterinarian we will vaccinate your pet here today.
Are Vaccines Current?*
- Yes
- No
What Veterinary Facility were the Vaccinations Given?
Boarding Drop Off Date:*
MM slash DD slash YYYY
Pick Up Date:*
MM slash DD slash YYYY
Pick Up Time:*
: Hours
Minutes
AM/PM
Current Diet/Feeding Schedule:*
Current Medications / Dosing:
May we treat any major/minor problems we find?*
- Yes
- No
- Please Call First
May we sedate your pet if absolutely necessary?*
- Yes
- No
- Please Call First
I request the following work to be done:
Disclosure Statement Authorization - I understand that Randhurst Animal Hospital will use every reasonable precaution to assure my pet’s safety while it is in their care and expect the veterinarian to use reasonable judgment should my pet develop any health problems. I consent to the administration of treatment/ medication should a situation arise and financial responsibility for all charges incurred during my pet’s stay. I agree to my pet (s) being photographed and for their image to be used on social media.*
I Authorize Treatment/Medication/Photos
Payment in full must be received upon pet pick-up. A $25 fee will be charged for returned checks.
Authorization Date:*
MM slash DD slash YYYY
Name: (This acts as your Digital Signature)*
First Last
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Very friendly, responsive and professional business and employees. Will be back without question. Got appointment within several hours of my call. Our lion feels great and is now super friendly and feeling better than ever. Price was right, results were spectacular. It doesn't get any better.

Amazingly friendly & knowledgeable staff! The hours are great & I’ve been able to schedule appointments same day. It’s very clear that they care about their patients. My dog actually likes going to the vet because of them!

Great experience! Groomer is phenomenal and techs are top notch. They are compassionate, kind and truly helped me with a very difficult scenario. They are GREAT with pets and people!

We have been taking our dog here for 2 years. I'm very happy with their service, and the prices are reasonable. They do a good job of explaining which vaccines are a must, which are optional, and under what circumstances you would want them. They seem to really enjoy the animals are enthusiastic to service.

Good experiences here. My cat has a disease and they’ve helped me manage it well and are always available for appts and advice. Dr kumar is friendly, knowledgeable and understanding.

Randhurst Animal Hospital

212 East Rand Rd., Mt. Prospect, IL 60056
Veterinarians serving Mt Prospect, Des Plaines, Arlington Heights, Northbrook, Glenview, Morton Grove, Rolling Meadows, Wheeling, Prospect Heights, Palatine and surrounding areas

Veterinary Website Design by Cheshire Partners

Randhurst Animal Hospital

212 East Rand Rd.,

Call Us

Request an Appointment

Randhurst Animal Hospital

Hospital Affiliations

Quick Links

Mt. Prospect Veterinary Services