Should your pet become unwell in our care, we print this form and take it to the surgery who will be treating your pet.

To prevent any errors, we can not 'manually edit' the content of this document. It is the pet owners responsibility to complete a new form should any details change.

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Pet/s Name/s:

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Your Full Name

Your Home Address

Your Postcode

Your Phone Number

Your Email Address

Your Partners Name & Phone Number

EMERGENCY CONTACT - We need the name and number of someone who does not travel with you case we (or the vets) can not get hold of you.

Emergency Contact Name & Phone number

Registered Veterinary Surgery

Vet's (Full) Address

Vet's Phone Number

1st Pet's Name

Colour/Breed

Male or Female

Male
Female

Date of Birth: (approximate)

Neuter/Spay Date (Type RESCUE if this was done by a rescue and you don't know when).

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

2nd Pet's Name

Colour/Breed

Male or Female

Male
Female

Date of Birth: (approximate)

Neuter/Spay Date (Type RESCUE if this was done by a rescue and you don't know when).

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General Health: Tick any conditions your pets have ever had

Mites, dandruff or a skin condition
Occasional dirty bottom
Regular dirty/Sticky bottom.
Bladder issues, stones or incontinence
Ear Infection or ear mites
Dental issues
Runny eyes
Abscess, tumour or any lumps.
Gut stasis (not eating/pooping)
Pasteurella (Snuffles).
Runny nose or Sneezing that needed medication.
E cuniculi related head tilt or hind leg paralysis.
Sore hocks or detached dew claw
Takes regular medication.
Stress in a new environment.
Bonded pair had a fight and fell out with one or both needing to see a vet.
Something not listed above
No Health issues / Never had any illness

Please give full details of any past or current health issues and any minor/major operations - with approximate dates if possible.

Which 'Pet Insurance Company' do you use and policy numbers for each pet please.

Anything else our vets will find useful if they need to treat your pet?

VETS VISITS : We will always try to contact you (or your emergency contact) if we suspect an illness or injury, and we have a duty of care (under the Animal Welfare Act 2006) to take your pets for veterinary treatment.

STAYING AT THE VETS : In some cases the vets may need to admit your rabbit for a short time or even overnight for monitoring and treatment by their veterinary team. At an Animal A&E 'Out Of Hours' clinic this could be in excess of £500 for one night.

Yes, I agree for my pet to be admitted for monitoring and treatment.
No, I do not agree for my pet to be admitted to the vets.

Veterinary Fees

Yes, I agree to pay for all veterinary fees myself
No, I do not agree to pay for any veterinary fees.
I will pay for any veterinary fees and claim from my pet insurance.

I have read the Terms & Conditions and Privacy Policy of the Garden Lodge Bunny Retreat and have electronically signed that I agree to all of the above for this and all future bookings.

I Agree
I do not agree

Date

Signed

User Agreement

I agree that all the details given above are correct.