Intake Form - New and Returning Clients

Name

First Name

Last Name

Phone

(###)

###

####

Address where pet(s) will be cared for

What is your Venmo handle or phone number associated with Zelle?

Please provide the following information about each pet. Include a separate paragraph for each pet.

Include: Name, Sex, Species, Breed, Birthday/Gotcha Day, Weight

Let's Talk Diet and Feeding Schedule

Details to include: time(s) of feeding, free feed, amount of food, treats, supplements, medications, restrictions/allergies

Play & Enrichment

Favorite toys, activities, any training you are currently working on, things to avoid, reactivity, etc.

Mood/Demeanor

I want to hear all about their personality! Any leash/dog aggression? Where do they hate being pet? Have they attempted an escape? Etc.

Anything else I should know?

Emergency Contact

Name and Phone Number

IN CASE OF EMERGENCY

In the event of the serious illness or death of my pet while in Provider’s care, I authorize Provider to make the following arrangements on my behalf . I will always attempt to contact you first, and then your emergency contact before making any decisions. This is in the event that I am unable to reach you. Veterinary Name/Doctor

Vet Address & Phone Number

Preferred Emergency Vet

Monetary Limit for ER Vet Care

*Please leave a credit card sealed and labeled in an envelope in your home, or have one on file at vet's office.

Pet Care Service Agreement

This Pet Care Services Agreement (“Agreement”) is entered into between Jessica Cornella (“Provider”) and You, the client. If viewing on mobile device, Agreement can be found at the bottom of this page. For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows:

What service(s) are you requesting

Drop-In Visit

Dog Walking

Scaredy Cat Visit (aproximately 15 Minutes)

Other

Dates and Times Requested

My day typically starts at 9AM ;) but happy to chat if there's a reason for an earlier start time.

Which best describes your pet care needs:

This helps me better serve all of my clients!

My pet is flexible, stop by any time!

My pet is semi-flexible, stop by during specific block of time.

My pet loves a schedule, please stop by at my requested visit time (please note, I require a 15 minute grace period)

It's complicated - let's chat more!

Meet & Greets (required for all new clients)

M&Gs give us both an opportunity to get to know each other, ask questions, and you can give me a tour of where your pet's belongings are. Please send me 3 days and blocks of time that work for you

How did you find out about me?

Do you have a promo code?

Preferred contact method

Text

E-mail

Phone