Consent Form

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Contact and Client Profile

Contact and Client Profile

Please print clearly using blue or black ink. Fill in all applicable fields to your best knowledge

CLIENT CONTACT INFORMATION

CLIENT CONTACT INFORMATION

Clients Full Name

Address

Mobile Number

Email Address

Work Number

EMERGENCY CONTACT INFORMATION

EMERGENCY CONTACT INFORMATION

Emergency Contact Name

Do they have a key?

Yes

No

Relationship to owner

Mobile Number

Work Number

Email Address

VET INFORMATION

VET INFORMATION

Vet Name

Vet Address

Phone Number

Opening Hours

Email Address

DOG INFORMATION

DOG INFORMATION

Dogs Name

Dogs Age

Sex

Male

Female

Neutered/Spayed

Yes

No

Fully Vaccinated

Yes

No

Is Your Pet Insured

Yes

No

Insurer

Crate Trained

Yes

No

Micro chipped

Yes

No

Tag on Collar

Yes

No

Treats Allowed

Yes

No

N/A

Allergies/Intolerances

Yes

No

More Information

Medical Conditions

Yes

No

More Information

Medication required

Yes

No

If yes please fill out medication form *

Has your Dog ever shown signs of aggression towards a person or another animal?

Yes

No

Please Explain Below

Any Behavioural Concerns

How does your dog respond to the following

How does your dog respond to the following - Given: 1 = BAD and 5 = GOOD

Cats

People

Small Dogs

Birds

Squirrels

Larger Dogs

FEEDING ROUTINE

FEEDING ROUTINE

Does your dog have wet or dry food?

Wet

Dry

Combination

Brand of Wet Food

Brand of Dry Food

Brand of Treats

Any further information?

Does your dog have treats, if yes what brand

How many treats per day?

When do they have treats?

Does your dog have any food allergies, intolerances or sensitivities?

Yes

No

If so, please explain

Is there anything you specifically don't want your dog to have

Yes

No

If yes, please give details

FEEDING PLAN

FEEDING PLAN

Breakfast

Time

Amount

Lunch

Time

Amount

Dinner

Time

Amount

Any other food?

Special Feeding Instructions

DOG BOARDING DETAILS

DOG BOARDING DETAILS

Start Date

End Date

Time of Drop Off

Time of Collection

How Many Walks a Day

Times Preferred

Will You Be out Of the Country

If yes, please provide an emergency number of where you are staying

Will It Be You Collecting Your Dogs upon Departure

Yes

No

If no, please provide name and number of person collecting

Name

Number

Is There Anything Else We Should Know

Would You Like Daily Updates and Pictures

Yes

No

What Time of Day Is Best to Message You

How Would You Prefer to Be Reached

Email

Text

Please provide the number or email you would like updates too

CLIENT CONSENT

CLIENT CONSENT

Client name

Date

Client Signature

Dog Boarder Name

Date

Dog Boarder Signature

Consent Forms for West Edge Pets

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