Registration Form | L.R.M Pet Services

Owners Details:

Owners Full Name *

Owners Contact Number *

Owners Address *

Owners Postcode *

Owners Email address *

Emergency Contacts Details:

Emergency Contact Name *

Emergency Contacts Phone Number *

Emergency Contacts Address *

Emergency Contacts Postcode *

Relationship to owners *

Friend
Family
Neighbour
Partner
Other

Pets Details:

Pets Name *

Pet Breed *

Pet Species *

Canine
Feline
Equine
Other

If ticked other species above then please specify what species your pet is below

Gender *

Male
Female

Neutered *

Yes
No

Pets age *

Microchip Number

Pets health, welfare and nutrition requirements

Pets Veterinary Details:

Pets Current Vet *

Vets contact number *

Vets Address *

Vets Postcode *

Is your pet 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

Up-to-date with Vaccinations? *

Yes
No

Date of when it was last given?

Up-to-date Kennel Cough vaccination? *

Yes
No
n/a

Date of when it was last given if known?

Up-to-date with worming treatment? *

Yes
No
n/a

Date of when it was last given if known?

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

Yes
No
n/a

Date of when it was last given if known?

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

More Information about your pet:

Good with other animals?

Yes
No
Sometimes
I like to chase sheep
I like to chase deer
I am scared of cats
I am scared/anxious of other dogs and may bite or bark at them
I like to chase birds

Are you happy for your dog to be walked with other dogs?

Yes
No

Good with people?

Yes
No
Sometimes

Happy to be posted on social media? *

Yes
No

Vehicles?

I am not great when travelling and need special attention e.g. travelling on the front passenger seat with seat belt attachment
I love going in a car/van for an adventure
I like to chase/ or scared of vans
I like to chase/ or scared of cyclists
I like to chase/ or scared of motorbikes
I like to chase/ or scared of cars
None of the above

Do you grant us your permission to let your dog off lead where we deem a suitable place to do so? *

Yes
No
n/a

Pets Favourite Treats:

Any other information that you may like us to know?

If you have more than one pet then please fill out another registration form for them too....thank you!