Medication Authorization Form Thank you for giving West Chester Pet Resort the opportunity to care for your pet(s). To ensure the best care possible, please fill out this form completely. We’ll reach out with any questions. Please enable JavaScript in your browser to complete this form.Client Name *Name *FirstLastEmail *PhoneI understand that West Chester Pet Resort will be administering medication during my pet’s stay. I also understand there is a medication fee for the administration of insulin $5.00/day for diabetic pets. *I Agree and UnderstandAll medications (this includes supplements, vitamins, oils, etc.) MUST be in their original prescription bottles/packaging to be accepted for administration -- NO EXCEPTIONS. All pets requiring medication while boarding MUST be checked in NO LATER than 10:30AM. *I Agree and UnderstandPlease thoroughly complete the table below to indicate the medication your pet will be given, how much, how often and the last time the medication was administered. Name of Medication *Example: Rimadyl 25mg Amount Given *How Often *Last Dosage Given (Date & Time) *DateTimeDo you have a 2nd medication? *YESNOName of Medication * Amount Given *How Often *Last Dosage Given (Date & Time) *DateTimeDo you have a 3rd medication? *YESNOName of Medication * Amount Given *How Often *Last Dosage Given (Date & Time) *DateTimeDo you have a 4th medication? *YESNOName of Medication * Amount Given *How Often *Last Dosage Given (Date & Time) *DateTimeDo you have a 5th medication? *YESNOName of Medication * Amount Given *How Often *Last Dosage Given (Date & Time) *DateTimeTo ensure your pet get's their medication, please let us know the best way to administer medication to them: *CheesePeanut ButterPill PocketsEN Meatball (canned dog/cat food)Owner ProvidedOtherIf other please explain:Special Medication Directions:Signature * Clear Signature Date *PhoneSubmit
