Aged & Special Needs Admission Form

1

Owner, Dog & Veterinary Details

Please enter your contact details and your regular vet clinic.

Your Name (as shown on your account) *

Contact Number (as shown on your account) *

Email Address *

Dog's Name *

Dog's Breed *

Please confirm the Vet clinic and Vet your dog has been seeing regularly:

Vet Clinic *

Vet Contact Number *

Preferred Vet

2

Health & Medical Assessment

Please complete the below in as much detail as possible. Select Yes or No for each condition.

Skin

No Yes

Ears

No Yes

Eyes

No Yes

Respiratory

No Yes

Chest / Heart

No Yes

Digestive / Dietary

No Yes

Liver / Kidney

No Yes

Arthritis

No Yes

Hips / Knees

No Yes

Allergies To Any Medications

No Yes

Most Recent Vet Visit *

Any Additional Information

3

Critical Care & Emergency Directives

In the unlikely event that your dog requires critical veterinary care.

In the unlikely event that your dog requires life or death treatment please leave instructions on how much treatment you would like to be given: *

In the case where you and your emergency contact is unavailable or unwilling to make a decision the Vet will make the best decision for your dog. Do you have an upper limit for the funds you would be prepared to spend on your dogs care? If you have pet insurance then please let us know: *

In the case of resuscitation being required, do you approve for the vet to proceed with CPR? *

Yes, please give CPR to my dog

No, DO NOT resuscitate my dog

4

Deceased Care Wishes & Declaration

In the event that your dog passes away in our care, please advise your wishes below.

If my dog passes away whilst in the care of the resort: *

I DO want to be contacted I DO NOT want to be contacted

Contact Details (Should you wish for someone other than yourself to be contacted please provide their name, phone number and email address):

Should my dog pass away whilst in the care of the resort: *

I would like the vet clinic that has treated my dog to store my dog appropriately until I return or have someone collect on my behalf. I would like the vet clinic that has treated my dog to organise a professional pet cremation for me to collect when I return. If the treating vet is not my regular vet I would like my dog to be transported to my vet listed in this form and I will organise with them the next steps.

Terms & Medical Authority Agreement

By completing this form, I agree to pay all costs and charges for any veterinary treatment for my dog during their stay at We Love Dogs Kennel Resort / Dogs Country Club & Kennel Resort. Please note that this form is updated annually or as conditions change. If your dog has special needs or is over the age of 10 we will ask that this form is completed for each visit to ensure we have the most up to date information for their upcoming stay. As per the boarding agreement signed at the time of arrival, I agree that the resort will act on my behalf should my dog require any vet care and I give full authority for them to do so in the instance they are unable to reach my provided emergency contact. I also give permission for our Vet to provide information to the Vet caring for my dog.

Signed Name *

Date *

Admission Directives Successfully Recorded!

Owner, Dog & Veterinary Details

Health & Medical Assessment

Critical Care & Emergency Directives

Deceased Care Wishes & Declaration

Terms & Medical Authority Agreement