Veterinary Information and Consent

Owner(s)(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Phone(Required)

Dog's Name(Required)

Breed(Required)

Age(Required)

Please enter a number from 0 to 99.

Medical conditions, if any

Additional Dog (Optional)

No Additional Dog

Skip this section if you do not have an additional dog.

Dog's Name

Breed

Age

Please enter a number from 0 to 99.

Medical conditions, if any

Vaccinations

Bordatella (kennel cough) due

Heart worm due

Flea/tick due

DHLPP due

Rabies due

Your Vet

Veterinary Clinic Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Clinic Phone(Required)

Upload Vet Records (if available)

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Emergency Conatct

Emergency Contact Name

Emergency Contact Phone

Signature / Agreement

I agree that I am the owner of the above dog(s) and give permission to On The Ball K9 Training LLC to act on my behalf, and in my pet(s) best interest, by providing veterinary care at my expense for illness or injury. I agree to pay for all veterinary and other necessary services incurred by and for my pet during its care with On The Ball K9 Training LLC. If neither of the veterinary clinics named above are available, I authorize On The Ball K9 Training LLC to take my pet(s) to another veterinary clinic for treatment. I understand that On The Ball K9 Training LLC cannot be held responsible for the treatment provided by the veterinary clinic or the loss of my pet(s). I further agree to be liable for the full amount of the bill and understand that the bill is due and payable when services are rendered. I will assume full responsibility for the payment of veterinary services rendered.

On The Ball K9 Training LLC agrees to provide reasonable care to prevent injury or illness to my pet(s). However, in the event of injury or illness, the owner of On The Ball K9 Training LLC shall not be held personally liable for such injury or illness.

Client's Name

Today's Date

Signature

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