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Pet Services Registration Form
This form must be filled out for all pets. They may all be included on the same form. If a new pet joins the family, another form must be filled out to address that pet.
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* Indicates required question
Email
*
Your email
Your name- First, Last
*
Your answer
Name(s) of others in the home/family who may have or retrieve house key.
*
Your answer
Services and Dates You Are Requesting
*
Your answer
Pet name(s)
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Your answer
Are there any other pets in the home that are not included in the requested service?
*
Your answer
Street address
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Your answer
City, State, ZIP
*
Your answer
Phone #
*
Your answer
Pet age(s)
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Your answer
Pet sex(es)
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Your answer
Spayed/neutered?
*
Your answer
If spayed/neutered, when?
Your answer
Pet breed(s)/mix(es) if known
*
Your answer
Pet(s) allergies, physical limitations, medical conditions
*
Your answer
Name of veterinarian(s) and practice(s)
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Your answer
May we contact your vet to let them know we're working together?
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Yes
No
Pet(s) medications (You may need to demonstrate medication administration to our service provider.)
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Your answer
If we suspect an emergency with your pet, what should we do? (Check ALL that apply.)
Note: If we suspect something is broken or life threatening, we will take them to the vet unless you come home within two hours or less (depending on the case.) We will not allow animals to suffer in our care.
Pet parents are responsible for all incurred fees for both veterinary and pet sitting services.
*
Contact me. I'll give you instructions.
Contact vet. Follow their instructions.
Contact me, but if I don't answer, call the vet. Do what they say.
Don't go to the vet. Call me and stay with my pet until I answer.
I have a financial limit. Have the vet call me once you get there.
I am leaving a credit card or Care Credit card for emergencies or have one on file at the vet's office.
Other:
Required
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