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Pet Information Form

The full record

Pet Information Form

This is the record we keep for every pet in our care, and it's what lets us care for your dog safely, meet our licensing conditions, and keep our five-star council rating. It's thorough on purpose.

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Part 1 of 7

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Part 1 of 7

Pet & Owner Info

Which location is this for? *

Chinnor Mitch and team · Chinnor South Wales Randle and team · Beddau

Owner Information

Title *

First Name *

Last Name *

Address Line 1 *

Address Line 2

Post Code *

Mobile Tel No. *

Home Tel No.

Email *

Pet Information

Pet Name *

Breed / Description *

Date of Birth *

Sex *

Spayed / Castrated *

Size *

Services Required *

Dog Home Boarding Dog Day Care Dog Walking Pet Home Visits Pet Sitting

1st Emergency Contact Info

Title *

First Name *

Last Name *

Address Line 1 *

Address Line 2

Post Code *

Mobile Tel No. *

Home Tel No.

2nd Emergency Contact Info

Title

First Name

Last Name

Address Line 1

Address Line 2

Post Code

Home Tel No.

Mobile Tel No.

Part 2 of 7

Property Description

Pet sitting and pet home visits only, or if your dog is being collected from your home for walking and you're not present. If you have requested dog walking and do not need us to collect your dog from your property, you may skip this section.

Security System (if applicable)

Security Company Name

Security Code

Security Company Phone No.

Password

Arming Instructions

Disarming Instructions

Property Description (if applicable)

Securely Fenced?

Pet Door/Flap?

Describe any problems with the fence (i.e. gate not easily latched, dog digs under fence etc)

Location of cleaning supplies (detergent, disinfectant, broom, dustpan, paper towels etc)

Location of dogs water bowl

Location of dogs lead, collar, harness

Location of dogs food

Location of water emergency shut off switch

Location of gas emergency shut off switch

Location of electricity emergency shut off switch

Will there be anyone else visiting the property whilst I am there (relatives, friends, cleaner)? If so, please explain who and when.

WiFi Code (if applicable)

WiFi Router location (if applicable)

Boiler/Thermostat location & information (if applicable)

Other information

Part 3 of 7

Pet Info

Some questions may not apply.

General Information

Chipped? *

Microchip Number *

Microchipped Registered Address? *

Dog wearing ID Tag? *

Description of Tag

Allowed Treats? *

Type of treats & quantity & when?

Is your dog generally crated / given the run of the house / placed outdoors / limited to... (Please explain) *

Does your dog live *

Are there any 'off limit' areas in the house (describe)? *

If yes, please describe

Preferred walking route/terrain? *

Typical walk duration? *

Special Walking Instructions

Where is the dog to be left after the walk? (if applicable)

Medical Information

Is your pet generally in good health? *

Health comments

Vaccinations * Please state the most recent dates by vaccination. Required vaccinations include: Leptospirosis, Adenovirus, Parvovirus, Canine Distemper. NB: At least 2 weeks must elapse after vaccination before service can commence.

Titre Test * (Alternative to Vaccinations) (Please contact us directly to discuss)

Has your pet received a Bordetella bronchiseptica/ Canine parainfluenza virus vaccination (Kennel Cough)? *

Vaccination date *

Parasite Treatment * Is your pet up-to-date with worming and flea medication? (Veterinary evidence will be required)

Medication Please give details (type/name) of any medication your pet is being prescribed and what condition this is for. (Medication Consent Form will be required later on)

Allergies * Does your pet have any allergies or food sensitivities (please describe)? If your pet does not have any allergies or food sensitivities, please just write "No" in the box.

Physical * Does your pet have any mobility issues?

Does your pet ever get car sick? *

Other Medical Considerations Are there any other medical conditions we should be made aware of?

Feeding

Times of Feeding *

Type and quantity of food to be provided *

Is your dog possessive over food? *

Does your dog eat food very quickly? *

Part 4 of 7

Behaviour

Behaviour Information

Describe your dog's typical behaviours *

Command words

Sit What command words does your dog know and what command words do you use?

Stay

Lie down

Other

Walk Back

Come

Other

Heel

Give paw

Walk(ies)

Other

How well does your dog obey command words? * 1 being "Once in a blue moon" and 5 being "I'd win Crufts"

Routines

Where does your dog usually sleep? *

Is your dog allowed on the sofa? *

Is your dog allowed on a bed? *

Reactions

How does your dog react to other dogs (on lead)? *

How does your dog react to other dogs (off lead) ? *

How does your dog react to other animals (on lead) eg cats, squirrels, wildlife, cattle? *

How does your dog react to other animals (off lead) eg cats, squirrels, wildlife, horses, cattle? Eg Chase, attack *

How does your dog react to children (on lead)? *

How does your dog react to children (off lead)? *

How does your dog react to other people (on lead)? *

How does your dog react to other people eg postman (off lead)? *

Does your dog ever jump up at people? *

Does your dog ever jump on furniture? *

Does your dog ever unduly Bark? *

Does your dog ever unduly Whine? *

Does your dog ever Chew Furniture? *

Does your dog ever Chew small objects eg pens, ball, envelopes, small objects? *

Does your dog ever Fight with other Dogs? *

Does your dog ever Scratch at carpets or doors? *

Does your dog ever make a Mess or Urinate in the home? *

Does your dog ever Dig? *

Has your dog ever Escaped from your house or garden? *

If yes, please describe

Has your dog ever Escaped or Run Away on a walk? *

If yes, please describe

Does your dog get Frightened easily? *

If yes, please describe

Does your dog Pull on the lead? *

Do you allow your dog off lead in public places? *

Has your dog ever Bitten or been bitten by another dog? *

If yes, please describe

Are there any breeds/ colour of dogs your dog doesn't like? *

If yes, please describe

Are there any special games your dog enjoys? *

Please list/describe

Does your dog like to play around water? *

If yes, please describe

Can your dog swim? *

If yes, please describe

Is it ok for your dog to play with other dogs *

If 'No', please explain

Does your dog have any aggressions towards other people or animals? *

If yes, please describe

Where does your dog like/not like to be touched? *

How does your dog react to being groomed? *

Is your dog possessive or protective over food, toys, chews, collar etc? *

If yes, please describe

Anything else Please provide details of any other behaviours or information we should know about?

Part 5 of 7

Vet's info

Veterinary Information

Name of Vet/Practice *

Address Line 1 *

Address Line 2 *

Postcode *

Vet Telephone No. *

Vet Out of hours emergency number *

Do you have pet insurance? *

Pet Insurer

Policy Number

Pet insurer telephone number

Have you completed and signed the Veterinary Release Form? *

Part 6 of 7

Vet Release

During my absence, MyWaggyTails will be caring for my pet(s). In the event of an emergency, I authorise you (veterinarian) to administer medical treatment and I will be responsible for payment to you (veterinarian) upon my return.

You and your pet's information

First Name *

Surname *

Pet's name *

Address line 1 *

Address line 2

Postcode *

Contact tel no. *

Email address *

Type / Description of animal *

Veterinarian Information

Vet Name *

Contact Tel No. *

Address line 1 *

Address line 2

Postcode *

Details of Out of Hours Service *

Known Medical Conditions *

Permissions

As the pet owner, I give permission to transport my pet(s) to the above veterinarian and authorise treatment in the event of an emergency or sickness. *

If this veterinarian is not available, I authorise the Pet Care Service Provider to transport my pet(s) to a veterinarian of the Pet Care Service Provider's choice and authorise treatment. If emergency care is needed after regular office hours, my pet(s) may be taken to the nearest Veterinarian Emergency Clinic/Hospital.

Yes No

I give permission to MyWaggyTails to approve treatment up to... * (Input maximum £ amount or "no limit")

Responsibility for Charges

I agree to be responsible for all charges upon my return including, but not limited to, vet fees, extra visit fees and transportation fees. *

Yes No

Extreme Circumstances

In Extreme Circumstances * I agree to authorise the veterinarian to euthanise my pet in extreme circumstances after all reasonable attempts have been made to reach me or my emergency contact. Funeral Arrangement Instructions: in the event of my pet's death, I would like my pet...

Release From Liability

I agree that MyWaggyTails is released from all liability related to the transportation to and from the veterinarian and treatment for sickness or emergency. This release will remain valid for all current and future visits unless a new release is signed. *

Yes No

Part 7 of 7

Consents

Terms & Conditions - I have read and consent. * (A copy is available on our website and on request)

GDPR Compliance - I have read and consent to your Privacy Policy * (A copy is available on our website and on request)

By signing this form, I agree that all of the aforementioned information which I have detailed in the Booking Form is correct. *

I consent that any changes that I, as the owner need to make, will be notified prior to any future bookings. *

Yes No

I agree that I cannot hold the Service Provider responsible for loss or injury incurred (to my own dog(s) or to another animal or person) as a result, unless the Service Provider is shown to be negligent. *

I give permission for the posting of pictures and videos of my dog(s) on social media and in any promotional materials. *

Yes No

I consent that in the event of aggressive behaviour, or an emergency, eg a bitch coming in to season (if applicable), I will arrange for my dog to be removed from the home boarding environment, either by myself the owner, my representative or for the dog to be placed in alternative kennels/boarding arrangements, at my cost. (if applicable) *

I consent to the enrichment and exercise programme provided as agreed with the Service Provider to include free running in the garden, walks, grooming, socialisation and play. *

Yes No

I consent to the use of a crate (only if the dog is already habituated to it). *

Yes No

I authorise the chosen veterinarian to administer medical treatment and I will be responsible for payment to the veterinarian upon my return. *

I consent to the Service Provider deciding which veterinarian is to be used. *

I consent to the Service Provider seeking a veterinary assessment and emergency treatment, if the Service Provider deems it necessary, and for the Service Provider to administer any medicines prescribed by the veterinarian. *

Yes No

I agree to fully update you, the Service Provider prior to any future service, for any behavioural change or medical change in my pet(s) * (Please note: vaccinations and anti-parasite treatments must be checked before every service).

I agree my dog(s) can share unsupervised time inside the home (up to 3 hours) during the working day (if required). *

NB Dogs will not be supervised during the night, although family members will be on the premises.

Yes No

I consent to my dog(s) being fed with other dogs whilst under the supervision of the Service Provider. *

Yes No

I consent to my dog(s) being transported for walks and any other requirements by the Service Provider. *

Yes No

I give consent for my dog(s) to be walked off the lead (subject to the walker's considerations for safety, group dynamics and the environment). No dog(s) will be allowed off the lead if consent is not provided, or if in the professional opinion of the Service Provider the dog(s) are not responding to commands, even where consent for off-lead exercise has been granted by the owner. *

Yes No

I consent to my dog(s) being walked outside of the home environment/garden with dogs from other households under the supervision of the Service Provider. *

Yes No

I consent to my dog(s) playing in the garden with dogs from other households. *

Yes No

I consent to my dog(s) sleeping together with dogs from other households in the same room. *

Yes No

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