CH Medication Form – Green Beagle Lodge

Medication & Supplement Form

Please complete the form below within 48 hours of your arrival at the Lodge. You will receive a confirmation email once it is fully submitted.

Please note that in order to ensure proper and accurate care for your pet, we need a new form each time you board with us.

Submitting this form does not create a reservation for your dog. This must be done first via your Owner Portal or by calling us at (919) 929-7387.

1Basic Information

2Medication/Supplement #1

3Medication/Supplement #2

4Medication/Supplement #3

5Medication/Supplement #4

6Medication/Supplement #5

7Final Confirmation

Basic Information

Primary Owner's Name(Required)

First Last

Email(Required)

Boarding Drop-Off Date(Required)

MM slash DD slash YYYY

Pet's Name(Required)

Total Number of Medications(Required)

Please enter a number from 1 to 5.

Please note that at this time our Medication/Supplement form only supports up to 5 medications per pet. If your pet requires more medication, please complete a second form.

Medication/Supplement #1

Medication name & strength as listed on the container(Required)

Your Pet's Dosage(Required)

What is the condition being treated?(Required)

Has your pet already received this medication today (day of drop off)?(Required)

Yes

When was it last administered?(Required)

What dosage was given?(Required)

Is this medication or supplement given as needed and not on a regular schedule?(Required)

Yes

What is the maximum single dosage that can be given?(Required)

What is the maximum frequency it can be given?(Required)

When should we administer this medication/supplement?(Required)

Noon

Other

If you selected 'Other', please specify:(Required)

How does your pet prefer to take the medication/supplement?(Required)

Peanut Butter

Pill Pockets

Cheese

Other

If you selected 'Other', please specify:(Required)

Please detail any additional instructions regarding this medication/supplement:

Please be as concise as possible.

Medication/Supplement #2

Medication name & strength as listed on the container(Required)

Your Pet's Dosage(Required)

What is the condition being treated?(Required)

Has your pet already received this medication today (day of drop off)?(Required)

Yes

When was it last administered?(Required)

What dosage was given?(Required)

Is this medication or supplement given as needed and not on a regular schedule?(Required)

Yes

What is the maximum single dosage that can be given?(Required)

What is the maximum frequency it can be given?(Required)

When should we administer this medication/supplement?(Required)

Noon

Other

If you selected 'Other', please specify:(Required)

How does your pet prefer to take the medication/supplement?(Required)

Peanut Butter

Pill Pockets

Cheese

Other

If you selected 'Other', please specify:(Required)

Please detail any additional instructions regarding this medication/supplement:

Please be as concise as possible.

Medication/Supplement #3

Medication name & strength as listed on the container(Required)

Your Pet's Dosage(Required)

What is the condition being treated?(Required)

Has your pet already received this medication today (day of drop off)?(Required)

Yes

When was it last administered?(Required)

What dosage was given?(Required)

Is this medication or supplement given as needed and not on a regular schedule?(Required)

Yes

What is the maximum single dosage that can be given?(Required)

What is the maximum frequency it can be given?(Required)

When should we administer this medication/supplement?(Required)

Noon

Other

If you selected 'Other', please specify:(Required)

How does your pet prefer to take the medication/supplement?(Required)

Peanut Butter

Pill Pockets

Cheese

Other

If you selected 'Other', please specify:(Required)

Please detail any additional instructions regarding this medication/supplement:

Please be as concise as possible.

Medication/Supplement #4

Medication name & strength as listed on the container(Required)

Your Pet's Dosage(Required)

What is the condition being treated?(Required)

Has your pet already received this medication today (day of drop off)?(Required)

Yes

When was it last administered?(Required)

What dosage was given?(Required)

Is this medication or supplement given as needed and not on a regular schedule?(Required)

Yes

What is the maximum single dosage that can be given?(Required)

What is the maximum frequency it can be given?(Required)

When should we administer this medication/supplement?(Required)

Noon

Other

If you selected 'Other', please specify:(Required)

How does your pet prefer to take the medication/supplement?(Required)

Peanut Butter

Pill Pockets

Cheese

Other

If you selected 'Other', please specify:(Required)

Please detail any additional instructions regarding this medication/supplement:

Please be as concise as possible.

Medication/Supplement #5

Medication name & strength as listed on the container(Required)

Your Pet's Dosage(Required)

What is the condition being treated?(Required)

Has your pet already received this medication today (day of drop off)?(Required)

Yes

When was it last administered?(Required)

What dosage was given?(Required)

Is this medication or supplement given as needed and not on a regular schedule?(Required)

Yes

What is the maximum single dosage that can be given?(Required)

What is the maximum frequency it can be given?(Required)

When should we administer this medication/supplement?(Required)

Noon

Other

If you selected 'Other', please specify:(Required)

How does your pet prefer to take the medication/supplement?(Required)

Peanut Butter

Pill Pockets

Cheese

Other

If you selected 'Other', please specify:(Required)

Please detail any additional instructions regarding this medication/supplement:

Please be as concise as possible.

Final Confirmation

Original Containers(Required)

Per state law, any and all medications or supplements must be provided within their original container or packaging and be accompanied by any associated instructions. This includes both prescription drugs and over-the-counter supplements.

The Green Beagle Lodge will be unable to accept or administer medications or supplements not provided in the original packaging and without a medication form. This may result in your pet not being able to be administered their required medications, or be unable to stay at the Lodge.

I agree to bring all medication/supplements in their original container/packaging.

Accuracy of Information(Required)

The above completed Medication/Supplement form will be used as the basis of care provided to your pet/s. The information provided will be used to accurately medicate your pet to the correct dosage, strength, and frequency.

I confirm that all information provided is accurate to the best of my knowledge

Signature