HOLIDAY SPECIAL: Jackson Galaxy Consultation Form

HOLIDAY SPECIAL!

Thank you for your interest in Jackson Galaxy's consultation special this holiday season. Please use the following form to tell us more about your cat(s) and submit payment. If you have any questions, please email office@jacksongalaxy.com.
Guardian Information
Guardian's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*
Email Address*
example@example.com
Names of Adults in the Household
Other people who regularly interact with animals in your home:
Your Cat's Information

Area for additional animals later on!
Name*
Age*
How & when did they join your family?*
Sex*
Altered?*
Altered when?

MonthDayYear
Date
Declawed?*
Declawed on Front or All Paws?
When was your cat declawed?

MonthDayYear
Date
Any current medications?*
Please list all medications.*
Any additional history you feel Jackson should know about?
Does your issue concern multiple animals?
Choose "Yes" to add information for an additional animal.

YesNo
Animal #2 Information
Name*
Species*
Age*
How & when did they join your family?*
Sex*
Altered?*
Altered when?*

MonthDayYear
Date
Declawed?*
Declawed on Front or All Paws?
When was your cat declawed?

MonthDayYear
Date
Any current medications?*
Please list all medications.*
Would you like to add an additional animal that is associated with this issue?*

YesNo
Animal #3 Information
Name*
Species*
Age*
How & when did they join your family?*
Sex*
Altered?*
Altered when?*

MonthDayYear
Date
Declawed?*
Declawed on Front or All Paws?
When was your cat declawed?

MonthDayYear
Date
Any current medications?*
Please list all medications.*
Other Animals in Your Home (Innocent Bystanders)

The Jackson Galaxy Consult Includes:

😻 One 60-minute video call with Jackson

😻 Cost: $750
And finally, the legal stuff...
Jackson Galaxy Consulting Agreement
I agree to indemnify and hold harmless Jackson Galaxy and Little Big Cat, Inc. for any liability arising from any injury or death to me, my cat(s), other animals, and/or to third parties resulting from the use of this service, as well as for any loss or damage to property, to me or to third parties resulting from any use of its services. I agree to reimburse Jackson Galaxy for any necessary expenses, reasonable attorney’s fees or costs incurred in the enforcement of any part of this indemnity agreement.
Signature*

Clear
My Products*
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HOLIDAY SPECIAL: Jackson Galaxy 60-Minute ConsultationA 60-minute virtual video-based consultation with Jackson Galaxy to talk about your cat(s)!
$750.00

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
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HOLIDAY SPECIAL!

Guardian Information

Your Cat's Information

Animal #2 Information

Animal #3 Information

Overview of the Issue(s)

Home Life

Typical Day

Feeding Schedule

And finally, the legal stuff...

Jackson Galaxy Consulting Agreement