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Hickory Pet Inn 2303 Hickory Road Plymouth Meeting, PA 19462 610-825-8895 Fax: 610-828-6167 Kennel Cough Informed Consent Pfold2MA here Brdg Dates: Thank you choosing Hickory Pet Inn to care for your pet during your absence. We make every effort to ensure our facility is free of diseases including Canine Infectious Tracheobronchitis (Kennel Cough) and Canine Influenza (CIV). Despite our best efforts we cannot guarantee that your pet will not be exposed to a strain of “Kennel Cough” or any other respiratory virus that is not covered by the current vaccine. With this being said, if your pet does present with signs of an upper respiratory infection (a dry hacking cough that ends with retch and/or nasoocular discharge) please call us as soon as possible. We need to be informed of any and all potential cases in order to safeguard the pets in our facility. I, the undersigned, have been informed and fully understand that my pet could possibly contract Infectious Tracheobronchitis or Canine Influenza despite being vaccinated. In the event that my pet does become ill, Hickory Veterinary Hospital will evaluate at no charge but any diagnostics, medications and /or treatment will be at my expense. _____________________________________ ___________________ Owner/ Authorized Representative Date KCIC 11/15 mbr