Ruff Riders LLC. Consent Form
This document serves as a formal agreement between the Pet Owner and Ruff Riders LLC. The purpose of this form is to ensure that all necessary information regarding the care, safety, and medical needs of the dog are documented and understood by all parties involved.
Owner Information
Name
*
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
Dog Information
Dog's Name:
*
Breed:
*
Age/date of Birth:
*
Gender:
*
Male
Female
Spayed/Neutered
*
Yes
No
Microchip Number (if applicable):
*
Emergency Contact Details
In the event that the Owner cannot be reached, the following individual is authorized to make decisions regarding the dog's care:
Emergency Contact Name:
*
Relationship to Owner:
*
Phone Number:
*
Veterinary Information
Veterinary Clinic Name:
*
Primary Veterinarian:
*
Clinic Address:
*
Clinic Phone Number:
*
Medical History and Care
Current Medications (Dosage and Frequency):
*
Allergies (Food, Environmental, or Medicinal):
*
Existing Medical Conditions:
*
Current and Up to Date on All Required Vaccinations
*
Yes
No
Behavioral Notes and Routine
Aggressive History/Biting other dogs:
*
Yes
No
Temperament and Socialization with Other Dogs:
*
How Does Your Dog React When Meeting New Dogs:
*
Known Triggers or Fears (e.g., storms, loud noises, bicycles):
*
Does Your Dog Have a Certain Reaction to Any Size or Breed of Dogs:
*
Emergency Medical Authorization
In the event of a medical emergency, I, the undersigned Owner, hereby authorize the Ruff Riders LLC. to seek professional veterinary care for my dog. I understand that the Ruff Riders LLC. will first attempt to contact me and my designated emergency contact. If neither can be reached, I authorize the Ruff Riders LLC. to act on my behalf and make decisions based on the recommendation of a licensed veterinarian.I agree to be solely responsible for all costs associated with emergency veterinary care, including but not limited to examinations, diagnostic tests, surgeries, and medications. I further release Ruff Riders LLC. from any liability related to the administration of such care or the outcomes thereof, provided that Ruff Riders LLC. acted in good faith.
By signing below, I acknowledge that the information provided is accurate and that I agree to the terms set forth in this Consent Form.
Signature (Your consent will be recorded)
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: