Furr'd Intake and Emergency Contact Form
Owner Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
While I am away, I prefer to be contacted by
Phone Call
Text
Email
Select the service(s) of your interest
*
Overnight Boarding - $45
Puppy Overnight Boarding- $50
Training - $40 per hour
Weekend Drop In - $30 (within a 10-mile radius)
Transportation Services - $15 one-way (within a 10-mile radius)
Additional services offered
Transportation Services - $15 one-way (within a 10-mile radius)
Transportation Services - $30 roundtrip (within a 10-mile radius)
Other
What dates will you need services?
Pet Information
Tell me about your animal(s)
Pet 1: Name, Age, Breed, and Weight
*
Pet 2: Name, Age, Breed, and Weight
Pet 3: Name, Age, Breed, and Weight
Is your pet spayed or neutered?
*
Yes
No
Does your pet have the required vaccinations? (check all that apply)
*
Bordetella
Rabies
DPP (Distemper, Parvovirus & Parainfluenza)
Other
Upload a copy of your pet's vaccination record
Browse Files
Cancel
of
Care Needs
Does your dog have any medical problems (seizures, painful conditions, etc.)?
*
Yes
No
If yes, please list them and explain any accommodations or support needed
Is your pet on any medications that needs to administer?
*
Yes
No
If yes, please provide the medication(s), dosage(s), and when and how to administer
What is your pet's feeding schedule and routine? (please include food type, quantity and any additional instructions)
*
Please list any food restriction or known allergies
*
Where does your pet sleep?
*
If your pet needs to be crated or confined, how do they react?
*
Please describe your pet's exercise needs
*
Does your pet have any of the following behavior concerns (check all that apply)
*
Fear or reactivity to strangers
Fear or reactivity to animals (outside or on leash)
Resource guarding or aggression around food, places, or objects
Escape behaviors (from confinement, or property)
Other
Please describe in more detail the behaviors you selected above, and how you manage them
Any other behavioral quirks or concerns I should be aware of?
Describe a typical 24 hour day for your pet(s)?
Emergency Contacts and Vet Information
In the unlikely event of an emergency, I will use need this information to be correct and up to date.
What should I do the event of an emergency requiring veterinary care? (see emergency policy below for more information)
*
Contact me first
Seek immediate veterinary attention
Contact my secondary contact first
What is the best phone number to reach you at, in case of an emergency?
*
-
Area Code
Phone Number
What is the name of your primary Vet or Vet Clinic?
*
Primary Veterinarian's Phone
*
-
Area Code
Phone Number
Does your primary veterinarian have 24h emergency hours?
*
Yes
No
If No, please list the name, and number of the closest 24-hour Emergency vet
Secondary Contact: In the event that you cannot be reached, Is there someone to contact for additional support?
*
First Name
Last Name
Secondary Contact Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Policies Acknowledgment
Furr'd by T. Reid, LLC will endeavor to create as safe an environment as possible for the care of my animal(s) and will offer only an sound, safe, and responsible environment. However, I recognize that Furr'd by T. Reid is not responsible for any unintentional errors, omissions, or incorrect assertions. Further, I am and will remain responsible for the actions of my animal(s) at all times and I hereby agree to indemnify and hold harmless Furr'd by T. Reid, LLC of any and all claims of injury, expense, costs, or damages of any kind while under the care of Furr'd by T. Reid, LLC. Emergency Care: In the event that I cannot be reached, Furr'd by T. Reid has my permission to react to a situation as deemed appropriate, and or necessary for the health and safety of my animal(s), or others. I attest that I am responsible for compensating Furr'd by T. Reid for any monetary charges made for items and or services including but not limited to, vet bills, pet food, or human medical attention. I certify that the information shared on the intake is true. By checking the box below, I agree to and accept the above policies.
*
I agree and acknowledge
Submit
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