Emergency Contact Information
Resort Check in Date
*
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Month
-
Day
Year
Date Picker Icon
Pet Information
*
Pet #1 Name
Pet #2 Name
Pet Information
Pet #3 Name
Pet #4 Name
Client Information
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Alternate/Emergency Contact Information
*
First Name
Last Name
Alternate/Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate/Emergency Contact Relationship
*
(ex: Spouse, Friend, Neighbor)
In the event an injury or unforeseen health emergency arises, we make every effort to obtain approval for a treatment plan. We encourage pet owners to consult with their family members to determine an emergency care directive to be used in the event we are unable to reach a pet owner or emergency contact.
*
I authorize ANY AMOUNT necessary for the treatment of my pet while in the care of Raintree Pet Resort + Medical Center.
I authorize the maximum AMOUNT SPECIFIED BELOW to be used towards my pet's Emergency Care at Raintree Pet Resort + Medical Center.
Amount authorized for emergency treatment in the event Raintree Pet resort + Medical Center is unable to reach myself or the emergency contact provided:
In the event a non-emergency incident arises including minor gastrointestinal upset(vomiting, diarrhea, or lack of appetite), isolated instances of non traditional behavior, or minor abrasions from group play:
*
I authorize supportive care or environmental adjustments as Raintree Pet Resort +Medical Center feels appropriate to care for my pet in my absence.
I wish to be contacted for authorization prior to any non-emergency treatments
I authorize the maximum amount specified below to be used towards non-emergency care at Raintree Pet Resort + Medical Center
Amount authorized for non-emergency treatment in the event Raintree Pet resort + Medical Center is unable to reach myself or the emergency contact provided:
Signature
*
Date
*
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Month
-
Day
Year
Date Picker Icon
Submit
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