Pet/s Name/s:
___________________________________________
Your Full Name
Your Home Address
Your Postcode
Your Phone Number
Your Email Address
Your Partners Name & Phone Number
We need a name and phone number of a friend or relative who is NOT GOING AWAY WITH YOU - In case the vet can’t get hold of you. This will be ‘YOUR EMERGENCY CONTACT,
Your friend or relatives: Name & Phone number
1st Pet's Name
DOB or Approximate Age:
Male or Female
Neuter or spay date (If done by a rescue type ‘RESCUE’)
Colour/Breed
2nd Pet's Name
Pet Insurance (Pets Names) Insurance Company & Policy Number/s
Are your rabbits: (Tick All That Apply)
PAST MEDICAL HISTORY
Tick anything your pet has ever had
Please give full details of any past or current health issues.
YOUR VETERINARY SURGERY
Vet Company Name & Address
Vet's Phone Number
Is your pet registered with any other vets or a specialist vet?
If you answered YES to the above - which other vet are you registered with?
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.
Anything else?
STAYING AT THE VETS : If you rabbit has suspected Gut Stasis the vets may need to admit them for a short time, or even overnight for monitoring and treatment.
Veterinary Fees
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.:
Date:
Signed:
User Agreement
