Case by Case Pet Services

If you are an existing client, click here.

PLEASE NOTE:  All requests must be confirmed by our office.

New Client Information:
Name		Work Phone
Address		Home Phone
City, State, Zip		Cell Phone
Email		Confirm by
Service Request

Begin Service		Visits on this day
		Visits on other days
End Service		Visits on this day

Preferred Time for Visits:      Morning Afternoon Evening
Dates you are available for initial consultation at your home (prior to service dates)
Pet Information
Pet 1

Type	If other, what type?	Breed/Variety	Name
	Spayed/Neutered	Microchip	Sex
Age	Yes No	Yes No	Female Male
Pet 2
Type	If other, what type?	Breed/Variety	Name
	Spayed/Neutered	Microchip	Sex
Age	Yes No	Yes No	Female Male
Pet 3
Type	If other, what type?	Breed/Variety	Name
	Spayed/Neutered	Microchip	Sex
Age	Yes No	Yes No	Female Male
Pet 4
Type	If other, what type?	Breed/Variety	Name
	Spayed/Neutered	Microchip	Sex
Age	Yes No	Yes No	Female Male
Pet 5
Type	If other, what type?	Breed/Variety	Name
	Spayed/Neutered	Microchip	Sex
Age	Yes No	Yes No	Female Male

Emergency Information
Please list emergency contacts in case we can't reach you.
Name	Phone	Relationship:
Name	Phone	Relationship:
Who else has keys to your home?
Name	Phone	Relationship:
Name	Phone	Relationship:
Will anyone be staying in your home?    Yes No
Veterinary Information
Name	Phone
Credit card on file with vet?    Yes No
Are all animals current with vaccinations?    Yes No
Is any animal on medication?    Yes No		If yes, explain
Details of animal care routine, if any:
Other information:
Additional Pet Services requested:
Giving Medication	Dog Walk	Bathing
Vet Visit	Litter Box	Overnight Stay
Bandage Change	Cage Cleaning	Pet Taxi
Exercise Therapy	Pet Relaxation Session	Special Request
Pet Temperature	Pet Massage
Household Services:
Water Plants	Take out Trash/Recycling	Pick Up Mail
Alternate Lights	Leave Radio On	Leave TV On
Alternate Blinds
Other Service Providers at your home:
Housekeeper Name	Days	Phone
Yard Caretaker Name	Days	Phone
Other Name	Days	Phone
How did you hear about us?