Reason for Visit: Reason for Visit: Reason for Visit: Training Walking Settling in day Overnight

Owner Name:

Telephone No:

Email Address:

Address:

Emergency Contact Name:

Emergency Telephone No:

Dog Name:

Dog Age:

Dog Breed:

Dog DOB:

Last Vaccination Date:

Neutered/Spayed: Neutered/Spayed: Yes No

Please tick to confirm Please tick to confirm Worming and Flea treatments up to date?

Does your dog have insurance? Does your dog have insurance? Yes No

If yes please provide details:

Vets Name:

Vets Contact No:

Vet Address:

Any medical needs? Any medical needs? Yes No

Medical Details: If yes please provide details of any allergies, medication provided and dosage instructions

House trained? House trained? Yes No (If no, unfortunately I can’t have your dog to stay; but happy to discuss & address any training needs)

Daily Routine Please advise if there is a usual time your dog walks, how long for & any toys he/she likes; essentially anything I need to know

Are you happy for walks off lead in parks / open spaces? Are you happy for walks off lead in parks / open spaces? Yes No

On Lead only On Lead only Yes No

Signed - The Vet’s daughter: SaveClear

Signed - Owner: SaveClear

Date: