Should your pet become unwell in our care, we email or print this form for the vet who will be treating your pet.

To prevent any errors, we can not 'manually edit' the content of this document.It is the pet owners responsibility to complete a new form should any details change.

It is the pet owners responsibility to complete a new form should any details change.

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Pet/s Name/s:

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Your Full Name

Your Home Address

Your Postcode

Your Phone Number

Your Email Address

Your Partners Name & Phone Number

EMERGENCY CONTACT - We need the name and number of someone who does not travel with you case we (or the vets) can not get hold of you.

Emergency Contact Name & Phone number

Registered Veterinary Surgery

Vet's (Full) Address

Vet's Phone Number

1st Pet's Name

Colour/Breed

Male or Female

Male
Female

Date of Birth: (approximate)

Neuter/Spay Date (Type RESCUE if this was done by a rescue and you don't know when).

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

2nd Pet's Name

Colour/Breed

Male or Female

Male
Female

Date of Birth: (approximate)

Neuter/Spay Date (Type RESCUE if this was done by a rescue and you don't know when).

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Tick anything your pet has ever had

STOPPED EATING
GUT BLOCKAGE
MITES or SKIN condition
STRESS due to - new environment, moving house or boarding or new baby/pet
Something with their EARS
Something with their EYES
A LUMP or TUMOUR
BLADDER stones or incontinence
Something with their TEETH
RUNNY NOSE or Sneezing that needed medication.
EC/ ecuniculi (head tilt or hind leg paralysis)
SORE HOCKS
BROKEN BONES or DISLOCATION
AMPUTATED LIMB
Visible SCARS or OLD INJURIES
Never had any of the above
Has had something not listed
NEEDS DAILY MEDICATION

Please give full details of any past or current health issues and any minor/major operations - with approximate dates if possible.

Pet Insurance (Pets Names) Insurance Company & Policy Number/s

Is your pet registered with any other vets or a specialist vet?

Yes
No

If you answered YES we need full details of treatment and name of the other vet/surgery/surgery.

Anything else?

VETS VISITS : We will always try to contact you (or your emergency contact) if we suspect an illness or injury, and we have a duty of care (under the Animal Welfare Act 2006) to take your pets for veterinary treatment.

STAYING AT THE VETS : If you rabbit has suspected Gut Stasis the vets may need to admit them for a short time, or even overnight, for monitoring and treatment by their veterinary team. This treatment plan could cost in excess of £300.

Yes, I agree for my pet to be admitted for monitoring and treatment.
No, I do not agree for my pet to be admitted to the vets.

Veterinary Fees

Yes, I agree to pay for all veterinary fees myself
No, I do not agree to pay for any veterinary fees.
I will pay for any veterinary fees and claim from my pet insurance.

I have read the Terms & Conditions and Privacy Policy of the Garden Lodge Bunny Retreat and have electronically signed that I agree to all of the above for this and all future bookings.

I Agree
I do not agree

Date

Signed

User Agreement

I agree that all the details given above are correct.