New Client Enrollment Form

Pet Owner’s Name:

Address:

City:

State:

Zip:

Best Phone Number to Reach You:

Alternate Number:

Pet Information (if More than 1 Pet Please Check Off All that Applies):

Pet Name:

Dog:

Cat:

Other (please list):

Breed:

Age (if known):

Color/Markings:

Medical Conditions/Medications (please describe):

Any Special Instructions:

Type of Service(s) Requested (please check off all that applies):

Duration of Service (for Dog walk / Yard let-out & Small Pet / Cat sitting)

Please Specify a Number & What Days:

Overnight Stays:

Dates Needed:

From

Transportation

1 Hour Minimum

Time Needed:

Location of Trip (note: Your Pet Will Be Picked up And Dropped Off To/from Your Home):

How Will a Pet Sitter Gain Entry to Your Home?

Owner Will Provide a Key or Key Will Be Located

Keyless Entry, Code Is:

And Key Pad Is Located:

Where Is Pet Food Located?:

Where Are the Leashes or Harnesses Located?:

Name of Veterinary Hospital or Clinic:

Name of Preferred Veterinarian (if applicable):

Address:

City:

State:

Zip:

Your Pets Medical Information:

Your Pets Name:

Type of animal (dog, cat, etc.):

Age:

Color/Markings:

Microchip ID:

Is your pet on any medication?

Yes No

If yes, Please describe (name of medication, dosage, how many times/day is it given?):

Medical History (if applicable):

Special Instructions:

Is your pet UTD on his/her vaccinations?:

Yes No

Date of last check-up and vaccines received:

Veterinary Release Form

Owner Information:

Client’s Full Name:

Emergency Contact Name:

Emergency Contact Phone Number:

Authorization for Veterinary Treatment:

I, the undersigned, am the legal owner or authorized agent of the above named pet. I hereby authorize a representative of Supreme Pet Care Services, LLC to provide medical treatment, examinations, procedures, and any necessary medications or surgeries as deemed appropriate for my pet’s health and well-being. I understand that every effort will be made to contact me or my emergency contact in case of any emergencies or significant medical decisions that need to be made.

This arrangement is ongoing throughout the year. Should my pet require any immediate medical attention while under the care of Supreme Pet Care Services, LLC, I authorize you to provide treatment up to the amount of $__ and I will be responsible for the payment of your veterinary services.

Pet Owner’s Signature:

Date:

Release of Liability:

I acknowledge that there are inherent risks associated with the medical treatments and procedures. I release __ it’s veterinarians, staff members and associated personnel from any liability arising from treatment decisions for my pet.

By signing this form, I acknowledge that I have read and understand the contents and implications of the veterinary treatment release form. I authorize and consent to the medical treatment outlined above for my pet.

Owner Signature:

Date: