Owner's Name *

First Name

Last Name

Owner's Phone *

(###)

###

####

Is your pet(s) up-to-date with their vaccinations? *

Yes

No

Unsure

Does your pet/s have any allergies? *

Yes

No

Unsure

Veterinarian Clinic Phone

(###)

###

####

In the case of an emergency, I understand that I Dog Too will make every attempt to contact me and my emergency contact.

Agree

If no contact can be reached, I authorize I Dog Too to seek appropriate medical treatment for my pet(s).

Agree

I authorize I Dog Too and the Veterinarian caring for my pet(s) to share all medical records of my pet(s) with emergency vet clinics in an effort to provide the best care possible.

Agree

I agree to assume full responsibility for payment and reimbursement for any and all veterinary services rendered.

Agree

Acknowledged On *

MM

DD

YYYY