Enzo's Medical Release & General Info

Medical Release & General Info Form

Services you are signing up for:

Full Name

First NameLast Name

Partners Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Secondary E-mail

Primary Phone Number

Area CodePhone Number

Secondary Phone Number

Area CodePhone Number

Additional People who can pick up, deliver or receive information regarding your pup.

Emergency Contact (Other than yourself)

Full Name

First NameLast Name

Phone Number

Area CodePhone Number

Pet Information

Pets Name

First NameLast Name

Breed/Description

Male/Female

Spay/Neutered

Weight

Birthdate or Age

Microchip Number

License Number

Vetranarian Information

Vet Full Name

First NameLast Name

Clinic Name

Phone Number

Area CodePhone Number

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Vaccine History (Date of last vaccinations and health check)

DHPP

Flu Vaccine (influenza)

Bordetella Due every Year

Rabies

Health-Check Due Annually

Clean Fecal test Within the last 3mo

Flea Treatment Recommended

Flea Brand

Allergies (Please list)

Health History

Medical History (Illness, injury, surgery, allergies, skin problems, and any other problems that may limit your pup).

On going Medications

I understand that I WILL NOT bring my dog to the dog park, another Day camp or Boarding Facility within 16 days of my scheduled training at Enzo's Dog Training (Minimizes dog sickness)

Medical Illness or Problem Policy

If while under our care your dog becomes sick/ill, or hurt, we will make every attempt to call you on any phone numbers you provide, including your emergency contact. However, if we are not able to reach you please indicate below what you would like us to do:

Your Instructions:

Please check per your instructions

Authorized Vet

First NameLast Name

Authorized Vet Clinic

Vet Phone Number

Area CodePhone Number

Mark to Agree

*PLEASE NOTE* Enzos Acres cannot take dogs with grooming needs, past or present injuries, sick or that require special medical or dietary needs. This can interfere with the training & boarding process and requires more time and attention from our staff. If your dog becomes sick after you have booked for our services, please call us to reschedule those services for a time when your dog is healthy. Dawn - Enzo's Acres Inc.

Click to edit

MonthDayYear

Full Name

First NameLast Name

Partners Full Name

First NameLast Name

How Did You Find Us...Facebook, Google, if referral.. Who ?Referral ?

Please check all boxes that you understand our health regulations.

Sign here stating you understand all the terms above.

Agreement and Release