New Client Registration Form | Rusty's Furry Companions

Pet(s) MUST be up to date on ALL vaccines, Flea & Heart worm Prevention; unless stated by a Doctor. If available please provide a picture of your Furry Companion and Vaccine Information. If you have a Pet, such as, Dog, Cat, Horse, Fish or Other; please return to the Website and fill out the Proper Paper Work. We will contact you within 3 business days to set up a Phone Consult/Meet n Greet. Please be aware that ALL information has been filled out. We will email you a waiver to e-Sign once we receive your information. Please feel free to reach out with any questions you may have. Thank you for Contacting Rusty's Furry Companions where they are Loved just like Our Own.

Owner Information

First Name *Required*

Last Name *Required*

Phone Number *Required*

Email *Required*

Address

City

State | Province

Zip Code | Postal Code

Family Vet Clinic *Required*

How did you find us?

Emergency Contact (Include Phone Number)/Others Allowed to Pick Up

Owner Question #1: Who will be the MAIN person of contact? Please make sure I have the number

Owner Question #2: Who has LEGAL say over your pet if you are unavailable?This MUST be someone NOT in immediate family

Owner Question #3: Are you interested in any of the Additional Services/Memberships offered?

Pet #1 Information

Pet Name *Required*

Breed (Best Guess) *Required*

Sex *Required*

Color Description

Date of Birth

Rusty's Furry Companions requires proof of vaccination.

Rabies Expiration

DHPP/DAPP/FVRCP Expiration

Bordetella/FeLV Expiration

Heart worm Test/ Blood Draw Expiration

Fecal Expiration

Microchip Code

Weight

Insurance Info

Feeding Notes

Medication Notes

Temperament Notes (Aggression, anxiety, etc? If extensive, tell us in person).

Additional Notes (Anything else we should know? If extensive, tell us in person.)

Pet Question #1: Did you download the Pet Profile from website?

Mobile Phone Alert: Some phones have difficulty uploading the files below (the form gets reset after uploading). If this happens on your phone, please submit this form using a computer. You can also submit this form on your phone without uploading anything and then email your pet picture and vaccine verification document to us at rustysfurrycompanion@gmail.com. Thanks!

Pet Photo (Not Required. 5MB Max. Image Files Only)
Click to Upload Pet Picture

Proof of Vaccinations (5MB Max. Only Images, No PDFs. Take a Picture of Document with Your Phone and Upload It.)

Click to Upload a Picture of Proof of Vaccinations

Click Here to Add a Second Pet

Click Here to Add a Third Pet

ALERT: If you have more than three pets, submit this form once with your first three pets. After submitting the first time, click the link to come back to the form (shown after you submit the form) and fill out this form again with the information for your other pets. The second time you fill it out, you only need to include your name, phone and email in the OWNER section because the business will already have the other info (address, emergency contact, etc) from the first time you submitted the form.

Pet #3 Information