Registration Form | L.R.M Pet Services

Owners Name *

Owners Contact Number *

Owners Address *

Owners Email address *

Emergency Contact Name *

Emergency Contacts Phone Number *

Emergency Contacts Address *

Dogs Name *

Dogs Breed *

Gender *

Male
Female

Neutered *

Yes
No

Dogs age *

Microchip Number *

Dogs health, welfare and nutrition requirements *

Dogs Current Vet *

Vets contact number *

Vets Email *

Vets Address *

Is the dog on any medication? *

Yes
No

If yes what medication(s)? This is so we can watch out for any side effects while they are with us *

Good with other dogs? *

Yes
No
Sometimes

Good with other people? *

Yes
No
Sometimes

Up-to-date with Vaccinations (canine parvovirus, canine distemper, infectious canine hepatitis (adenovirus) and leptospirosis) *

Yes
No

Date of when is was last given?

Up-to-date Kennel Cough vaccination? *

Yes
No

Date of when is was last given?

Up-to-date with worming treatment? *

Yes
No

Date of when is was last given?

Up-to-date with tick & flea treatment? *

Yes
No

Date of when is was last given?

We will use the Old School Vet Practice in Broadford in the event of an emergency who will liaise with your own vets - *

Yes - by ticking this box you are giving L.R.M Pet Services your consent that you are happy for us to use the Old School Vet Practice on the rare circumstances that an emergency was to occur with your pet when in our care
No - by ticking this box you will have to supply us with your instructions of how you'd like us to proceed with your pet in the event of an emergency - which can be filled in below

Happy to be posted on social media? *

Yes
No

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