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Customer Details

About You
About Your Pet
2nd Contact

Pet Medical Form

About Your Pet
Vaccinations
Any Other information

Pet owner’s name:*
Email: *
Telephone number: *
Telephone number (additional/optional):
Pet owner address/pick-up and drop-off location: *

About Your Pet

Pet name: *
Pet nickname:
Pet breed: *
Pet sex: *
Pet age: *
What length of walk does your dog require? (minimum 1 mile): *

Days of the week required: *

Time of day needed: *

2nd Contact (Optional)

This person is able make decisions on the owner’s behalf in case the owner is unavailable.

Name:
Email:
Telephone number:
Address:
Does your dog have any specialist needs or requirements (e.g phobias, difficulty with recall, difficulty interacting with other animals)? 
If yes, please provide full details: *
Date your dog was microchipped: *
Name of database: *
Name of and address of veterinary practice (in the event that emergency treatment is required: *
Contact number for veterinary practice: *
Does your dog have any medical conditions? If yes, please provide full details including any medications: *
Date of last worm treatment: *
Date of last flea treatment: *

Vaccinations (confirm most recent vaccination/booster date if yes):

Head Office

  • Canis Otium Ltd
  • 128 City Road
  • London EC1V 2NX

Opening Times

  • Mon - Fri: 8am - 5pm
  • Saturday: 10am - 4pm
  • Sunday: CLOSED

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Canis Otium is a registered trademark. All rights reserved.