Pet Intake Form

Your Details

So we can reach you during the stay.

Your name

Mobile phone

Email (optional)

Home address (optional)

Emergency contact name

Emergency contact phone

Stay dates (optional)

Veterinarian

Who we should call if your pet needs care.

Clinic or vet name

Clinic phone

Clinic address (optional)

Acknowledgments

Please read and check each one.

My pet's vaccinations are current, and I can provide records if asked. To my knowledge my pet is healthy, free of fleas and ticks, and has not shown aggression toward people or other dogs beyond what I've described above. If my pet needs medical attention and I can't be reached, I authorize the caregiver to seek veterinary care, and I'm responsible for the cost. The information on this form is accurate and complete.

Owner signature (sign at drop-off)

Date

Back to Cost Calculator

Your answers are saved on this device as you type, so you can come back and finish later.

Your Details

Veterinarian

Acknowledgments

Your Pet