Client / Pet Information - Rediker Pet Transportation Services

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Rediker Pet Transportation Services

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Client / Pet Intake Form

Client Name *

First

Last

Phone Number

Address *

Email *

Pet Name *

Are we picking a :

Cat
Dog
Other

Description of "Other"

Pet Gender

Male
Female

Age of pet

Pet Breed

Pet Personality / Attitude

Calm / Friendly
Mean / Angry
Afraid / Anxious
Other ( Please specify below )

Reason for "Other"

Are there any pet fears that we should be aware of?

Pickup Address ( If not picking up at home ) *

Veterinary Services Drop off

Blueberry Creek Veterinary Hospital: (613) 264-2689, •50 Lanark Rd, Perth, ON K7H 3C9
Campbell Road Veterinary Clinic: (613) 283-2323, •R.R. # 5, 329 William Campbell Rd, Smiths Falls, ON K7A 4S6
Lanark Veterinary Clinic: (613) 284-0880, •88 Cornelia St W, Smiths Falls, ON K7A 4W7
McNeely Animal Hospital: (613-253-2602), •320 Coleman St #3a, Carleton Place, ON K7C 0B5,
North Lanark Veterinary Services: (613) 278-2158, •RR 3, Lanark, ON K0G 1K0
Perth Veterinary Clinic: (613) 267-7373, •118 Sunset Blvd, Perth, ON K7H 3C6
Smiths Falls Veterinary Services: (613) 283-4531, •250 Lombard St, Smiths Falls, ON K7A 5B8

Other Location *

Date and Time of Appointment *

Are we returning your pet to the Client Address after the appointment? *

Yes
No
Other

If you chose "Other", Please Specify

Will you require the use of our crates/carriers?

Yes
No

Will your pet travel "open back with barrier"

Yes
No

Will you require the use of our tablets for virtual meeting? (free of charge)

Yes
No

Will your pet require a ramp to enter the vehicle

Yes
No

Is your pet microchipped?

Yes
No

Pet Neutered / Spayed?

Yes
No

Is your pets' Rabies vaccine up to date? ( Required in Ontario )

Yes
No

Is your pet up to date on flea/intestinal parasite prevention (type)

Yes
No

Is there any other medical information that we should be aware of? (medications, allergies/food sensitivities, medical ailments (cancer, diabetes, anxiety), deaf/blind etc...

Have you acknowledged the "Use of Tablet Policy" (If applicable)

Yes
No

Have you acknowledged the "Consent, Waiver and Liability Release"

Yes
No

Have you acknowledged the "Confidentiality and Non-Disclosure Agreement - Rediker Pet Transportation Services"

Yes
No

Single Line Text

Multiple Choice

First Choice
Second Choice
Third Choice

Name *

First

Last

Home
About
Services
Contact
Agreements
Referral Program
Terms and Conditions
Advertise