Veterinarian Information Sample Clauses

Veterinarian Information. Name Clinic Phone Please list personal items brought for your birds stay (perches, toy/type, cage cover, etc): _ *BIRD PICKED BY DATE
Sample 1
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Veterinarian Information. Clinic: Phone: Fax: If your veterinarian office is not local and your pet(s) in need of emergency care, we will take your pet to the closest office with available hours during that time. Pet One: Name: Breed: DOB: Sex: Spayed/Neutered: Allergies: Suite Assignment: Feline ($15.00) Deluxe ($31.00) ARP ($32.00) For dogs over 12 years Does your pet have any of the following? Classic ($27.00) Grande Luxury ($39.00) Executive Suite ($49.00) Infection Communicable Diseases Parasitic Infestation Abnormality or other physical defect Other: Do you wish your pet to socialize with other pets? Yes No Is your pet accustomed to being crated or in a kennel? Yes No Is your pet housetrained? Yes No Can your pet jump fences higher than 5 ft? Yes No Has your pet ever been aggressive with another dog? Yes No Can we give your pet treats? Yes No Has your pet ever bitten anyone? Yes No Pet Two: Name: Breed: DOB: Sex: Spayed/Neutered: Allergies: Suite Assignment: Feline ($15.00) Deluxe ($31.00) ARP ($32.00) For dogs over 12 years Does your pet have any of the following? Classic ($27.00) Grande Luxury ($39.00) Executive Suite ($49.00) Infection Communicable Diseases Parasitic Infestation Abnormality or other physical defect Other: Do you wish your pet to socialize with other pets? Yes No Is your pet accustomed to being crated or in a kennel? Yes No Is your pet housetrained? Yes No Can your pet jump fences higher than 5 ft? Yes No Has your pet ever been aggressive with another dog? Yes No Can we give your pet treats? Yes No Has your pet ever bitten anyone? Yes No Pet Three: Name: Breed: DOB: Sex: Spayed/Neutered: Allergies: Suite Assignment: Feline ($15.00) Deluxe ($31.00) ARP ($32.00) For dogs over 12 years Does your pet have any of the following? Classic ($27.00) Grande Luxury ($39.00) Executive Suite ($49.00) Infection Communicable Diseases Parasitic Infestation Abnormality or other physical defect Other: Do you wish your pet to socialize with other pets? Yes No Is your pet accustomed to being crated or in a kennel? Yes No Is your pet housetrained? Yes No Can your pet jump fences higher than 5 ft? Yes No Has your pet ever been aggressive with another dog? Yes No Can we give your pet treats? Yes No Has your pet ever bitten anyone? Yes No Pet Four: Name: Breed: DOB: Sex: Spayed/Neutered: Allergies: Suite Assignment: Feline ($15.00) Deluxe ($31.00) ARP ($32.00) For dogs over 12 years Does your pet have any of the following? Classic ($27.00) Grande Luxury ($39.00) Executive Suite ($4...
Sample 1
Veterinarian Information. The SMCDA will contact the San Mateo County Health Officer (SMCHO) with details of any proposed treatment. If the SMCHO has questions about public health aspects of the program, Xx. Xxxxx Xxxxx, CDFA’ s Senior Medical Coordinator can be contacted at (000) 000-0000. Questions relating to Animal Health will be referred to CDFA’s Animal Health and Food Safety Services at (000) 000-0000. A “Veterinary Fact Sheet” may be prepared and provided for questions relating to pets or livestock. -
Sample 1
Veterinarian Information. All clients of “Home Is Where The Hound Is, LLC” are required to have a family veterinarian that may be contacted in the case of an emergency. If you do not have a family veterinarian, please write “Closest Emergency Vet” as the contact name. Name: Clinic: Address: City: State: Zip: Office Phone: ( ) Is your pet microchipped? Yes No By checking this box, I hereby acknowledge that my veterinarian is aware that we will be having a pet caregiver during our absence and any costs that are incurred for emergency veterinarian services during our absence for any of the pets listed in this agreement shall be paid for by us upon our return. Do You Have Pet Insurance? If yes, please provide policy information: Yes No Policy # Company: Contact #: By checking this box, I authorize my family veterinarian, listed on this agreement to make decisions regarding the welfare of my pet(s), also listed on this agreement, in the event that I (we) are not able to be contacted for authorization. This authorization shall only be valid during the period of care indicated in this agreement. 1 YR
Sample 1
Veterinarian Information. All clients of Pet Sitting by Xxxxxxxx are required to have a family veterinarian that may be contacted in the case of an emergency. If you do not have a family veterinarian, please write Closest Emergency Vet as the contact name. Name: Clinic: By checking this box, I hereby acknowledge that my veterinarian is aware that we will be having a pet caregiver during our absence and any costs that are incurred for emergency veterinarian services during our absence for any of the pets listed in this agreement shall be paid for by us upon our return. Address: City: State Zip: Office Phone: ( ) Is your pet microchipped? Yes No Do You Have Pet Insurance? Yes No By checking this box, I authorize my family veterinarian, listed on this agreement to make decisions regarding the welfare of my pet(s), also listed on this agreement, in the event that I (we) are not able to be contacted for authorization. This authorization shall only be valid during the period of care indicated in this agreement. Date of last Rabies immunization: 1 YR 3 YR Special Remarks About Any Pet: : Where Did You Hear About Us?
Sample 1
Veterinarian Information. We must receive a copy of your latest veterinary records before acceptance of your dog for boarding and/or daycare. You may bring the records in or have them emailed to xxxx@xxxxxxxxx.xxx or faxed to 000-000-0000. Veterinarian Office Name: Dr’s Name: Vet’s Address: Phone Number: Describe any medical/physical problems: Describe any medication your dog takes: Bark Avenue Pet Resort Authorization for Emergency Medical Treatment In the event your dog becomes ill, injured or medical treatment is necessary Bark Avenue will immediately try to reach you by the telephone number(s) listed below. If we are unable to reach you we must know what your wishes are. Please fill out the following information. Should an injury or illness occur to my dog that requires veterinary care during my absence, I authorize Bark Avenue to act as my agent in procuring essential veterinary medical care, with fees not to exceed $ . I agree to pay the fees for such veterinary services as soon as I can be contacted. I will not hold Bark Avenue liable for injuries or illnesses suffered by my pet or any fees for veterinary services incurred. Credit card to be kept in secure file. Name on credit card: Card Number: Expiration Date: The veterinary practice of my choice for medical care is: Name Phone Number I understand that the above listed veterinary practice may not be open in the event of an emergency. Therefore I authorize any veterinarian to provide medical care and services without my consent. Owner (1) Signature Date Phone Number Owner (2) Signature Date Phone Number
Sample 1

Related to Veterinarian Information

  • Medical Information Throughout the Pupil's time as a member of the School, the School Medical Officer shall have the right to disclose confidential information about the Pupil if it is considered to be in the Pupil's own interests or necessary for the protection of other members of the School community. Such information will be given and received on a confidential, need-to-know basis.

  • Technical Information The Employer agrees to provide to the Union such information that is available relating to employees in the bargaining unit, as may be required by the Union for collective bargaining purposes.

  • Patient Information Each Party agrees to abide by all laws, rules, regulations, and orders of all applicable supranational, national, federal, state, provincial, and local governmental entities concerning the confidentiality or protection of patient identifiable information and/or patients’ protected health information, as defined by any other applicable legislation in the course of their performance under this Agreement.

  • Product Information Contractor shall provide the following information for all goods provided pursuant to this Agreement: manufacturer’s name, product code number, and pack size.

  • Confidential System Information HHSC prohibits the unauthorized disclosure of Other Confidential Information. Grantee and all Grantee Agents will not disclose or use any Other Confidential Information in any manner except as is necessary for the Project or the proper discharge of obligations and securing of rights under the Contract. Grantee will have a system in effect to protect Other Confidential Information. Any disclosure or transfer of Other Confidential Information by Xxxxxxx, including information requested to do so by HHSC, will be in accordance with the Contract. If Grantee receives a request for Other Confidential Information, Xxxxxxx will immediately notify HHSC of the request, and will make reasonable efforts to protect the Other Confidential Information from disclosure until further instructed by the HHSC. Grantee will notify HHSC promptly of any unauthorized possession, use, knowledge, or attempt thereof, of any Other Confidential Information by any person or entity that may become known to Grantee. Grantee will furnish to HHSC all known details of the unauthorized possession, use, or knowledge, or attempt thereof, and use reasonable efforts to assist HHSC in investigating or preventing the reoccurrence of any unauthorized possession, use, or knowledge, or attempt thereof, of Other Confidential Information. HHSC will have the right to recover from Grantee all damages and liabilities caused by or arising from Grantee or Grantee Agents’ failure to protect HHSC’s Confidential Information as required by this section. IN COORDINATION WITH THE INDEMNITY PROVISIONS CONTAINED IN THE UTC, Xxxxxxx WILL INDEMNIFY AND HOLD HARMLESS HHSC FROM ALL DAMAGES, COSTS, LIABILITIES, AND EXPENSES (INCLUDING WITHOUT LIMITATION REASONABLE ATTORNEYS’ FEES AND COSTS) CAUSED BY OR ARISING FROM Grantee OR Grantee AGENTS FAILURE TO PROTECT OTHER CONFIDENTIAL INFORMATION. Grantee WILL FULFILL THIS PROVISION WITH COUNSEL APPROVED BY HHSC.

  • Plan Information The Employee agrees to receive copies of the Plan, the Plan prospectus and other Plan information, including information prepared to comply with Applicable Laws outside the United States, from the Long-term Incentives website and stockholder information, including copies of any annual report, proxy and Form 10-K, from the investor relations section of the Company's website at xxx.xx.xxx. The Employee acknowledges that copies of the Plan, Plan prospectus, Plan information and stockholder information are available upon written or telephonic request to the Company Secretary. The Employee hereby consents to receive any documents related to current or future participation in the Plan by electronic delivery and agrees to participate in the Plan through an on-line or electronic system established and maintained by the Company or a third party designated by the Company.

  • - CLEC INFORMATION CLEC agrees to work with Qwest in good faith to promptly complete or update, as applicable, Qwest’s “New Customer Questionnaire” to the extent that CLEC has not already done so, and CLEC shall hold Qwest harmless for any damages to or claims from CLEC caused by CLEC’s failure to promptly complete or update the questionnaire.

  • Project Information Except for confidential information designated by the City as information not to be shared, Consultant agrees to share Project information with, and to fully cooperate with, those corporations, firms, contractors, public utilities, governmental entities, and persons involved in or associated with the Project. No information, news, or press releases related to the Project, whether made to representatives of newspapers, magazines, or television and radio stations, shall be made without the written authorization of the City’s Project Manager.

  • CONTRACT INFORMATION 1. The State of Arkansas may not contract with another party:

  • KYC Information (i) Upon the reasonable request of any Lender made at least five (5) days prior to the Closing Date, the Borrowers shall have provided to such Lender, and such Lender shall be reasonably satisfied with, the documentation and other information so requested in connection with applicable “know your customer” and anti-money-laundering rules and regulations, including, without limitation, the PATRIOT Act, in each case at least five (5) days prior to the Closing Date.

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