Charlie & Chums Pet Services

Drop-In Visit Registration Form

About You

Owner's Name

Address

Phone

To send invoices, service agreement & future newsletters

Emergency Contact Name

Emergency Contact Number

Does your emergency contact have access to the property?

Yes

Roughly what time of day would be required?

8-11am

11-2pm

2-5pm

5-8pm

Set times aren't available so we offer a time frame for arrival.

About Your Pet(s)

Please complete all relevant sections for your Pet(s).

If you have multiple Pets, please complete each answer for all pets. if your pets have different needs, please put a name before each response.

Name of Pet(s)

Age & Date of Birth(s) (If Known)

Sex

Is your pet neutered (If applicable)?

Is your pet microchipped?

If yes, please tell us the microchip number.

Is your pet insured?

If yes please tell us the company, policy number & expiry date.

Health Section

Please note that the information in this section will be shared with a vet if your pet requires emergency treatment whilst in our care, and therefore must be clear and accurate.

Vet Practice Name & Address

Vet Practice Number

Vet Practice Out of Hours Service

Please write the address & phone number of our of hours service.

Have you registered Charlie & Chums Pet Services as an approved medical decision maker with your vet?

Yes

This helps to remove any GDPR difficulties at the vet practice.

Do you agree that your pet may be taken to another (nearer) vet if the treatment required is urgent?

Yes

Is your emergency contact registered with your vet and able to make medical decisions for you?

Yes

This helps to remove any GDPR difficulties at the vet practice.

Is your pet up to date with vaccines? Including kennel cough (If applicable).

If yes, please provide the date of the last vaccination

Is your pet regularly wormed and treated for flea prevention?

If yes, please provide details of the worming & flea treatment frequency.

Any medical concerns or requirements?

If yes, please provide details of your pets medical condition.

Does your pet take regular medication?

If yes, please provide details if the pet may require medication whilst we are visiting.

Does your pet have any allergies?

If yes, please describe your pets allergy symptoms and required treatment.

Pet Food and Snacks

What do you feed your pet?

Please tell us the brand of food that you feed your pets. This infomation would be needed by a vet if we had to take your pet for emergency treatment.

What is your pet's feeding routine?

Please describe breakfast, lunch and dinner as required. Tell us the quantity of each food, and details on any supplements that need to be added. Also indicate if your pet has a preferred place in the house to be fed.

Does your pet always finish their meals?

Behaviour Section

Please note that the questions in this section are used to establish the right experience for your pet(s) - so please be honest, There is no expectation of perfection.

Is your pet comfortable being picked up?

Does your pet have any areas of the body where they do not like being touched?

Is your pet friendly with strangers?

Has your pet ever bitten anyone?

If yes, please provide details

How does your pet demonstrate that they are unhappy?

Cats Only

Is your cat a indoor or outdoor cat?

If outdoor, is your cat easy to call in for meals etc?

Dogs Only

If your dog will not toilet during a visit, Shall we take the dog out of the house?

If yes, Where is their lead, Harness, Collar & Coat kept?

Caged & Other pets Only

Is your pet an Indoor or Outdoor pet?

Does your pet mind strangers putting their hands into the cage?

Please let us know the speical needs for any other pet (Not cats or dogs)

Pet Hygiene

Is your pet housetrained?

Where are prodcuts stored for cleaning up indoor accidents?

House Section

Is there anything else you would like us to do while we drop in?

Please note we will try our best to do extras if we have time.

Do we need to leave a light on or open/close curtains when we leave?

Do you wish for us to hold a key for you?

If you have a key safe please do not enter the details in this section. Please discuss this with me.

Do you use CCTV within your home? If yes what rooms are recorded on the CCTV?

Does your property have an alarm?

Yes

If you have a alarm system please do not enter the details in this section. Please discuss this with me.

Additional Notes

Please inform me of any additional information you think is required here.

Declaration

I hereby confirm that I am the owner of the pet(s) named on this form and that I authorise Charlie and Chums Pet Services to act as my pet’s guardian whilst providing care services.

I authorise Charlie and Chums Pet Services to take any action considered reasonable and appropriate in order to protect my pet(s) and keep it in good physical and mental health, including admission for veterinary treatment. I further confirm that I will be responsible for unexpected costs which may be incurred relating to my pet(s) whilst in the care of Charlie and Chums Pet Services (costs such as but not limited to veterinary care, equipment and property damage).

If my pet(s) is unwell, and I am not able to be contacted, I give Charlie and Chums Pet Services permission to authorise emergency veterinary treatment on my behalf.

I attest that the information I have provided in this document is an accurate account of my pet’s needs and behaviour. I am aware that if my pet(s) behaves in a manner which is dangerous to a person or another animal in Charlie and Chums Pet Services care, I will be contacted immediately and must address the issues before the commencement of further services. I undertake to keep Charlie and Chums Pet Services informed of any changes in my pet’s health, behaviour, or medical needs before making each new booking.

I agree that this consent shall remain in effect until it is superseded with a new version.

I agree to Charlie and Chums Pet Services Terms and Conditions & Service Agreements that are linked below and found on our website.

Terms & Conditions

Service Agreement

We take photos and videos to send to you during our stay, Can we post these on social media?

Yes

Feel free to follow us on socials:

Facebook, Instagram & Tiktok: @charlieandchumsuk

We also have a pet supplies business!

Etsy: https://www.etsy.com/shop/CharlieAndChums

Or find us on Tiktok Shop

Signature

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