New Client Forms

Pet Owner Information *

First

Last

Phone (Mobile) *

Phone (Home)

Phone (Work)

Email Address *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Name(s) *

Emergency Contact Number(s) (seperate with comma) *

Tell us about your pet

Pet Name(s) *

Breed(s)

Color(s)

Veterinarian Clinic Name

Vet Phone

Clinic Address

Address Line 1

Address Line 2

City

State

Zip Code

Has your pet been socialized with people other than household members?

Yes
No

Is your pet crate trained?

Yes
No

Does your pet experience car sickness?

Yes
No

If yes, is medication required?

Yes
No

Can your pet have treats?

Yes
No

Does your pet have allergies of any kind?

Yes
No

If yes, please describe:

Are your pet’s vaccinations current?

Yes
No

Vaccination record required, can you provide said record?

Yes
No

(Let us see what you have, we’d be happy to help.)

Does your pet have any mobility or movement restrictions we should know about?

Yes
No

Tell us about it (we can provide a ramp for van entry and exit):

Anything else you’d like us to know about your pet?

By checking the box below, I acknowledge and agree that I have read and understand all the information above, and have answered all questions to the best of my ability. I also acknowledge that Dogxi does it’s best to keep my pet safe and happy and to hold Dogxi harmless from illness and/or accidents regarding my pet.

Acknowledge & Agree

Today's Date:

Guidelines and Basic Information

HEALTH: Owners must certify their pet(s) are in good health and have not been ill with a communicable disease within the last 30 days. This rule applies to each trip your pet may take. Pet(s) must be free of any condition that could potentially jeopardize the health and/or safety for all clients and their pets. Pet(s) with any communicable disease in the last 30 days will require a good health certification for a veterinarian clinic. Pet(s) also have be able to be confined in our comfortable areas while in transit.

AGE & VACCINATIONS for DOGS: Dog(s) must be old enough to have had at least the first round of the distemper/parvovirus combination vaccine. Proof of vaccination must be presented before dog's first trip.

PET BEHAVIOR (mostly applied to dogs): We strive to make your pet as comfortable as possible as they get from A to B. This is why we provide a free meeting before our first trip. Let us meet your dog(s) and introduce them to the van. We are confident that we can make them comfortable. Should your dog(s) exhibit any behaviors deemed unsafe during or after the initial meeting, Dogxi owner(s) or staff will have the authority to remove the animal from our transportation program. Keep in mind that we may be able to work more closely with making your pet comfortable, at an additional cost.

SCHEDULING and CANCELLATIONS: Appointments AND cancellations are to be made at least by the previous day or earlier. Last minute appointments are possible but may be susceptible to a $10 charge plus regular fees.

BASIC PRICING: Our pricing is based on driving times. Driving times start from time of pickup to time of drop off. Prices subject to change.

MINUTES:
15 - $25
30 - $50
45 - $75

Additional charges may be added for treats and/or bones, but only with owner permission.

PAPERWORK: All pet(s) must have a complete, up-to-date, and approved paperwork and Client Agreement forms on file.

PAYMENT: We accept cash, credit and debit cards. Payment due at time of drop off.

By clicking the checkbox below, I certify that I have read and agree to all of the information above. *

I agree to Guidelines & Information

Owner’s e Signiture:

Pets Name(s)

Today's Date:

Client Agreement - Release and Waiver of Liability

I hereby waive and release Dogxi from all liability pertaining to the matters set forth below. *

Agree to Terms & Conditions

Required:

I acknowledge, agree and represent that I understand the nature of the business and I am aware of the possible risks and dangers associated with transportation. These risks include but are not limited to the following:

a.) The risk associated with travel to and from locations, including transportation provided by commercial and/or private motor vehicles.

b.) The possibility of pet injury incurred while getting on or off (in or out) the of transportation being used.

c.) The possibility of pet injury or loss/death in the event of a motor vehicle accident.

I hereby waive and release Dogxi from all liability pertaining to the matters set forth below. (copy) *

Agree to Terms & Conditions

In the event of any illness or injury, I hereby consent to whatever medical treatment or hospital care from a licensed veterinary physician and/or surgeon as deemed necessary by Dogxi owner/staff, for the safety and welfare of my pet(s). It is understood that the resulting expenses will be the responsibility of the owner. (Whenever possible, attempts will be made to contact the owner prior to taking any medical action.) *

Agree to Terms & Conditions

I understand that I am solely responsible for all harm and damages caused by my pet(s) while under care of Dogxi. *

Agree to Terms & Conditions

I agree to inform Dogxi of all risks associated with my pet that are known to me, or that should be known to me, whether or not such risks are specifically asked about on the first page under Pet and Owner information. *

Agree to Terms & Conditions

I shall indemnify, hold harmless, and release Dogxi against any and all claims, demands, damages, and costs, including attorney’s fees, made against it based on injury or damages caused by my pet(s), this also includes but is not limited to, any kind of known or unknown issues arising from my pet(s) attendance and participation with Dogxi transportation and care. *

Agree to Terms & Conditions

I further understand and agree that in enrolling my pet(s) with Dogxi, I certify that my pet(s) are in good health with no communicable conditions of any kind and haven’t had any communicable deceases within the last 30 days (this applies to each trip). I further certify that I have informed Dogxi about any and all past incidents wherein my pet(s) has harmed, threatened or behaved aggressively towards any persons. *

Agree to Terms & Conditions

I understand that by signing this waiver and release, I expressly and willingly agree to assume complete responsibility for any risk of injury, personal property damage, pet loss/theft, or death that may arise while Dogxi is watching my pet(s), property and/or home. On behalf of myself, I waive all claims of damages, injuries, diseases, pet loss/ theft, and death sustained to my pet(s) or my property, that I may have against Dogxi. *

Agree to Terms & Conditions

By clicking "Submit" below, I certify that I have read, understand, and agree to the rules and regulations set forth by Dogxi and have read and understand this agreement. I agree to abide by the rules and regulations and accept all terms, conditions, and statements of the agreement.

Pet owners e Signiture:

Today's Date