Pet Information. The care and services provided under this Agreement shall be for the following pet(s): ☐ ☐ Name: Age: Gender: Male Female Species/Breed: Description (e.g. color): Health Conditions: Behavior History: Medication(s) (Name and Dosage): Feeding Instructions: ☐ ☐ Name: Age: Gender: Male Female Species/Breed: Description (e.g. color): Health Conditions: Behavior History: Medication(s) (Name and Dosage): Feeding Instructions:
Pet Information. You are providing the following information about the Dog, which you promise is true, complete and correct to the best of your knowledge on the date of this Agreement. You agree that we have permission to contact the veterinarian listed for additional information. Please explain your answers in the blank lines.
Pet Information. The care and services provided under this Agreement shall be for the following pet(s): Name: ________________________ Age: ________________________ Gender: ☐ Male ☐ Female Species/Breed: ______________________________________________________________________ Description (e.g. color): ________________________________________________________________ Health Conditions: ____________________________________________________________________ Behavior History: _____________________________________________________________________ Medication(s) (Name and Dosage): _______________________________________________________ Feeding Instructions: __________________________________________________________________ Name: ________________________ Age: ________________________ Gender: ☐ Male ☐ Female Species/Breed: ______________________________________________________________________ Description (e.g. color): ________________________________________________________________ Health Conditions: ____________________________________________________________________ Behavior History: _____________________________________________________________________ Medication(s) (Name and Dosage): _______________________________________________________ Feeding Instructions: __________________________________________________________________
Pet Information. CLIENT requests the services to include the care for the following pets: Pet 1: Name: Breed Age: Sex: Birthday: Color: Medicines: Food: Pet 2: Name: Breed Age: Sex: Birthday: Color: Medicines: Food Pet 3: Name: Breed Age: Sex: Birthday: Color: Medicines: Food: Pet 4: Name: Breed Age: Sex: Birthday: Color: Medicines: Food: Pet 5: Name: Breed Age: Sex: Birthday: Color: Medicines : Food :
Pet Information. You are providing the following information about the Animal, which you promise is true, complete and correct to the best of your knowledge on the date of this Agreement. You agree that we have permission to contact the veterinarian listed for additional information. Medical History (Copy of veterinary records required for documentation): General Health and vaccination history: (Please fill out the accompanying document to give us a more thorough background on the dog) Are vaccinations current? Yes ____ No ____ Please list on accompanying document Are there any immediate medical needs? Yes ____ No ____ If Yes, explain: __________________________________________________________ ____________________________________________________________ ____________________________________________________________ Name and phone number of Veterinarian: _____________________________________________________ Name of the person the records are under with the Veterinarian: _____________________________________________________ Does the animal have any aggression issues? Yes ____ No ____ If Yes, please explain in detail: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Are there any ongoing medical issues? Yes _____ No _____ If Yes, please explain in detail including treatment given: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Please take the time to fill complete the questionnaire attached and send along with the animal when picked up.
Pet Information. Name of Pet: Type of Pet: Description (Breed/Size/Colour/Age/Weight): Spayed/ Neutered: Yes/No Current on Vaccinations: Yes/ No Pet Registration Number:
Pet Information. Pet name __ Breed Sex Age Color/Markings Rabies exp. Please list any health or mobility issues How does this pet behave at the groomer? Has your pet shown aggression toward other animals? Has your pet shown aggression toward humans? Please list any special instructions here:
Pet Information. Pet’s name Circle one Guinea Pig Rabbit Hamster Rat Color and description Sex Approximate Age Spayed/Neutered Microchip number Adopter Information Rabies tag number Full Name Address City State Zip Home phone ( ) Cell phone ( ) Work phone ( ) Email
Pet Information. The care and services provided under this Agreement shall be for the following pet(s): Name: Age: Gender: ☐ Male ☐ Female Species/Breed: Microchip Number: Vaccination: ☐ vaccination (date) ☐ worming ☐ flea treatments Description (e.g. color): Health Conditions: Behavior History: Medication(s) (Name and Dosage): Feeding Instructions: Name: Age: Gender: ☐ Male ☐ Female Species/Breed: Description (e.g. color): Health Conditions: Behavior History: Medication(s) (Name and Dosage): Feeding Instructions: ☐ Consent to feed with other dogs ☐ Consent to keep with other dogs ☐ Consent to walk off-lead
Pet Information. Is animal a certified service animal as defined by the ADA or a pet? Yes No Name of Animal: _________________________________ Type of Animal:_______________________ Animal’s Age:_____________ Animals Weight Is the Animal Licensed? Yes No Pet’s Emergency Contact: _________________________________ Phone #:_____________________ Has animal ever caused injury to others or been the subject of a lawsuit? __Yes __No Veterinarian Information: Vet: ____________________________________________ Phone: ____________________________ Location: ___________________________________________________________ Is animal spayed/neutered: Yes No Are the animal’s vaccinations current? __Yes __No
