Longs Peak Animal Hospital

Veterinary Hospital and Pet Boarding Day Care Longmont CO

Forms

Owner Information Form

By signing in the box above, I certify that the information given herein is true and complete to the best of my knowledge. Individuals listed on this form will be authorized to make medical decisions regarding all patients associated with this account.

Prescription Refill Request

Online Pharmacy Waiver

In keeping with our efforts to provide your pets with the best care available, we want our clients to be able to make an informed decision regarding the use of internet pharmacies. Our Online Pharmacy Waiver details some important risks to keep in mind when making this choice.

If you still choose to use an online pharmacy, the waiver needs to be signed and will become a part of your pet’s medical record. After requests are approved by a veterinarian, a written prescription will then be made available for pick-up. LPAH will not mail or fax prescriptions.

For additional information about internet pharmacies, please visit the AVMA website by clicking here.

I hereby request a prescription for purchase from an internet pharmacy or catalog vendor. I have been informed that the following risks exist when I obtain these products from such sources:

1. Internet sites that sell pet drugs can be reputable pharmacies. However, others are
fronts for businesses breaking federal, state, and sometimes, international laws. Illegal online pharmacies may sell medicines that are counterfeit, outdated, mislabeled, incorrectly formulated, or improperly made or stored. These medicines may not contain the actual drug, may contain contaminants or the incorrect amount of drug, may not work as well due to age or being stored in conditions that were too hot, cold, or humid, and may not have the proper directions for use.

2. As the provider of your pet’s care, our medical records keep track of all drugs dispensed by us to you. When prescriptions are purchased elsewhere, we are unable to print instructions for use or to send reminders for follow-up exams or lab tests that may be needed to monitor results or adverse reactions.

3. You may not have the prescription drugs available soon enough to start your pet’s medications at the optimal time to provide relief for his or her condition.

4. The number of tablets or capsules, milligram size of the unit, volume and/or concentration of liquid, and number of authorized refills may differ from that prescribed by the attending doctor.

5. Manufacturer rebates that would ordinarily be available for products purchased from this hospital are not available. Also, manufacturer warranties or guarantees for these products are not valid with internet or catalog prescriptions. This means that if your pet’s condition is not effectively treated with the product, manufacturers will not stand behind their products or product liability procedures.

I have read and understand the above, accept these risks, and am aware that Longs Peak Animal Hospital cannot accept any financial responsibility for paying for or reimbursing me for any treatments required as a result of the use of products purchased from internet pharmacies. In the absence of negligence, I agree to hold this veterinary practice harmless for any deleterious effects or lack of effectiveness of drugs purchased from any other source.

In keeping with our efforts to provide your pets with the best care available, we want our clients to be able to make an informed decision regarding the use of internet pharmacies. Our Online Pharmacy Waiver details some important risks to keep in mind when making this choice.

 

If you still choose to use an online pharmacy, the waiver needs to be signed and will become a part of your pet's medical record. After requests are approved by a veterinarian, a written prescription will then be made available for pick-up. LPAH will not mail or fax prescriptions.

I hereby request a prescription for purchase from an internet pharmacy or catalog vendor. I have been informed that the following risks exist when I obtain these products from such sources:

1. Internet sites that sell pet drugs can be reputable pharmacies. However, others are fronts for businesses breaking federal, state, and sometimes, international laws. Illegal online pharmacies may sell medicines that are counterfeit, outdated, mislabeled, incorrectly formulated, or improperly made or stored. These medicines may not contain the actual drug, may contain contaminants or the incorrect amount of drug, may not work as well due to age or being stored in conditions that were too hot, cold, or humid, and may not have the proper directions for use.

2. As the provider of your pet’s care, our medical records keep track of all drugs dispensed by us to you. When prescriptions are purchased elsewhere, we are unable to print instructions for use or to send reminders for follow-up exams or lab tests that may be needed to monitor results or adverse reactions.

3. You may not have the prescription drugs available soon enough to start your pet’s medications at the optimal time to provide relief for his or her condition.

4. The number of tablets or capsules, milligram size of the unit, volume and/or concentration of liquid, and number of authorized refills may differ from that prescribed by the attending doctor.

5. Manufacturer rebates that would ordinarily be available for products purchased from this hospital are not available. Also, manufacturer warranties or guarantees for these products are not valid with internet or catalog prescriptions. This means that if your pet’s condition is not effectively treated with the product, manufacturers will not stand behind their products or product liability procedures.

I have read and understand the above, accept these risks, and am aware that Longs Peak Animal Hospital, PC cannot accept any financial responsibility for paying for or reimbursing me for any treatments required as a result of the use of products purchased from internet pharmacies. In the absence of negligence, I agree to hold this veterinary practice harmless for any deleterious effects or lack of effectiveness of drugs purchased from any other source.

By signing in the box above, I certify that I have read and understand the above Online Pharmacy Waiver Form.

Boarding and Daycare Agreement

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Add An Additional Pet
Add An Additional Pet
Add An Additional Pet
GENERAL TERMS:

A. Longs Peak Animal Hospital (LPAH) is receiving the animal(s) above described for the purpose of Boarding, Daycare or any other service ordered by Owner or Owner’s agent, at the expense of and for the account of Owner. Owner agrees to pay the sum as specified for all chosen services.

B. Owner shall pay all costs and charges of and for special services, and all veterinary and medical costs that may be incurred during the time LPAH is responsible for the care of the animal(s) above described.

C. Owner recognizes that LPAH may require a non-refundable deposit on bookings or full payment in advance.

D. Owner agrees that LPAH will not be responsible for the destruction or loss of any toys, leashes, collars, bedding or any other property left with the animal.
VACCINATION POLICY:

A. Owner represents that prior to acceptance of the animal by LPAH, Owner will provide a copy of current vaccination records and a current “kennel cough” or Bordetella vaccination for animal, stating that all vaccinations are up to date for the entire stay at the kennel.

B. To ensure the protection of all pets under our care, including your own, the following must be up to date:
    DOGS: Rabies, DHPPC & Bordetella
    CATS: Rabies & FVRCP

C. If not up to date, or if unable to provide proof of vaccination, I give permission to update my pet(s) vaccinations in accordance with the policies of LPAH. If any fleas/ticks are observed on your pet(s) while boarding, he/she (they) will receive a flea bath/dip at the owner’s expense.

LIABILITY:

A. LPAH shall not be liable for any damages to the animal arising out of or from the boarding or keeping of the animal or that may accrue from any cause in connection with such boarding, including loss by fire, theft, running away, death, or injury during the term of this agreement, whether the animal is on the premises of LPAH or not, except where any such loss is caused by the neglect or intentional act of LPAH or by any of LPAH’s agents or employees. In the unlikely event of death, no final course of action will be taken without consent of the owner. However, Owner shall be solely responsible for all costs associated with disposition of a body.

B. In no case shall LPAH be liable for the animal’s acts and behavior, other than for the exercise of gross negligence on the part of LPAH, its agents or employees, in the boarding or keeping of the animal. Owner shall indemnify LPAH from and against any and all damages sustained or suffered by reason of the boarding or keeping of the animal for any claims or injuries arising out of the boarding and keeping of the animal.

LIEN FOR CHARGES:
A. LPAH shall have a lien on the animal for all unpaid boarding and other charges resulting from the boarding or keeping of the animal under this agreement.

B. Payment for services pursuant to this agreement is due and payable on the day of delivery of animal to Owner. Owner agrees that in the event the specified boarding charges are not paid when due and payable, in accordance with the terms of this agreement, LPAH may exercise its lien rights, and in connection with such rights, may dispose of the animal for any and all unpaid charges, at private or public sale, after 10 days’ notice to Owner of such unpaid charges. In the event such sale does not secure a sufficient price to pay the costs of board and other charges, plus costs of sale, owner shall pay to LPAH the difference.

ILLNESS OF PET:

One of the advantages of boarding your pet(s) at a veterinary clinic or hospital is that veterinary attention is readily available should the need arise. In the event your animal becomes ill, every attempt will be made to contact Owner at the phone number(s) listed in this agreement. If Owner does not immediately inform LPAH regarding measures to be taken or if the animal’s health requires emergency action, the right to provide medical treatment within LPAH’s discretion is granted to LPAH, and Owner shall promptly pay any expenses incurred in connection with such care.

DAYCARE:

All dogs enrolled in LPAH Daycare will be engaging in social play with other dogs. LPAH will supervise playtimes and will use reasonable care to ensure that injuries do not occur. Owner agrees that in the event that an injury does occur, all veterinary charges required to properly treat the animal for such injury are the sole responsibility of the Owner.

PAYMENT FOR SERVICES:

Charges are due and payable at the time of service, unless other arrangements are made in advance. Unscheduled or late pick-ups may result in additional fees. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance left unpaid will be forwarded to a collection agency, and will incur a 25% collection fee for which Owner is liable, in addition to monthly finance charges. A signature indicates that you have read and agree to the above information regarding your animal(s) while under the care of LPAH:
LPAH to use my pet’s likeness in a photograph or video in any and all of its publications, including website entries and social media, without payment or any other consideration. I understand that these materials will become the property of LPAH and will not be returned. I also authorize LPAH to edit, alter, copy, exhibit, publish or distribute this photograph or video for purposes of publicizing its services, and I waive the right to approve the finished product where my pet’s likeness appears.
By signing in the box above, you indicate that you have read and agree to the above information regarding your animal(s) while under the care of LPAH:

Holiday Boarding Agreement

For the purposes of this agreement, “Holiday Periods” are defined as any boarding stay that includes one or more of the following national holidays:

New Year’s Day

Easter

Memorial Day

4th of July

Labor Day

Thanksgiving Day

Christmas Day

Owner understands that if the boarding stay takes place over a Holiday Period, the reservation must be prepaid in full when the reservation is made.

Owner understands that if the entire Holiday Period reservation is canceled with less than two weeks of notice, Owner forfeits the reservation prepayment, including all fees paid for Daycare, a One-on-One, or any other boarding stay upgrade defined in the original reservation.

Owner understands that if only a portion of the Holiday Period reservation is canceled with less than two weeks of notice (late check-in, early check-out, etc.), Owner will not be refunded for the unused days of the reservation or for any special fees paid to include Daycare, a One-on-One, or any other boarding stay upgrade defined in the original reservation.

Owner understands that there is no check-in or check-out available on any of the national holidays listed above. On these days, the LPAH Boarding and Daycare department is only staffed to provide care for the boarding animals and is not staffed for administrative purposes.

By signing in the box above, you indicate that you have read and agree to the above information about special procedures during the holidays: