All clients must complete this form prior to leaving your pet(s) at our facility. Complete this form online to save time on your first visit. There are three sections to this form, and all sections must be completed. When you submit the completed form, an email with the information you provide and a copy of your digitally signed contract will be sent to you and to our office.
1 Start2 Pet Information3 Emergency Information4 Contract & Policies
YOUR INFORMATION
Client Name *
First
Last
Address *
Address Line 1
Address Line 2
City
State
Zip
Email *
Primary/Cell Phone *
May we text your mobile phone? (No ads, just updates about your pet, appointment reminders, account information, questions, etc.) *

Alternate Phone
OTHERS WHO MAY PICK UP YOUR PET
Name
First
Last
Email
Phone
Other Information
Do we have your permission to use photographs of your pet(s) in our website, flyer, ads, and brochures? *

How did you hear about Rex & Roxy's? *