Client/Pet Information - Rex and Roxy's of Buckhead

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 four pages to this form, and all pages must be completed. When you submit the completed form, an email with the information you provide will be sent to you and to our office.

1Start

2Pet Information

3Agreement

4Policies

Your Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Cell Phone*
Alternate Phone
Others Who May Pick Up Your Pet
Name
First Last
Email
Phone
Vet Information
Vet's Name*
Address
City State / Province / Region
Phone*
Emergency Contact (other than vet)
Name*
Phone*
Emergency veterinarian care authorized (see Agreement, No. 5)
Do we have your permission to use photographs of your pet(s) in our website, flyers, ads and brochures*
How did you hear about Rex & Roxy's?*

Pets Name	Breed	Age	Actions

There are no Pets .

This is a Contract between Austin Pet Care Centers GA04, LLC d/b/a Rex & Roxy's of Buckhead (hereinafter referred to as "Company") and the pet owner whose signature appears below (hereinafter referred to as "client"). By signing this contract and leaving said pet with Company, client certifies to the accuracy of all information given about said pet on the Client Information and Additional Pet Information forms.
1. Client specifically represents that he or she is the sole owner of the pet, or is authorized to act on the owner’s behalf.
2. Client assumes any expense or liability for injuries that Client’s pet may inflict upon any human or other pet while in Company.
3. Client agrees to promptly pay all charges for services rendered; at the rates in effect during the time said pet is in the care of Company.
4. Client is solely responsible for the health and wellbeing of their pets upon departure from Company premises.
5. If pet becomes ill or if the state of the pet’s health otherwise requires professional attention, Company, in its sole discretion, may engage the services of a veterinarian or administer medicine or give other requisite attention to the pet. Client gives consent to Company to act in the Client’s behalf in obtaining emergency veterinary care at Client’s expense if deemed necessary by Company.
6. Client releases Company and all of its employees from any and all liability for injuries to yourself or your pet which may occur at Company.
7. This contract contains the entire agreement between the parties. All terms and conditions of this contract shall be binding on the heirs, administrators, personal representatives and assigns of the Client and Company.
8. Client has read and understood the “Policies” form. While Company will do everything within their power to prevent the undesired consequences that can occur when groups of dogs and/or cats play together, Client acknowledges that by bringing their pet(s) to Company they are exposing them to the potential, however slight, of nicks, scratches, bites, other injuries, contagious diseases, and parasites.
9. This contract shall remain in effect for a period of one year from the signing date.
Untitled*
- I have read and accept the terms of this agreement
Sign by Typing Your Full Name*

Temperament Test
A Temperament Test, or Pre-Boarding Evaluation, is performed on every new dog before they can board or participate in day care. Overly aggressive dogs will not be allowed, nor will dogs that put the staff, other dogs, or themselves at risk. If a dog has not visited us within 6 months, they may need to be re-evaluated.
Vaccinations
We require up to date DHLPP (distemper, parvo), kennel cough (bordetella), and rabies vaccinations. State regulations dictate that we have written proof of vaccinations on hand. You may bring them with you or have your Vet fax them to us at (404) 816-4110.
Flea Control
Dogs and cats that attend Rex & Roxy’s of Buckhead must be free of fleas, ticks, and ear mites. If your pet is found to have fleas or ticks, we will bathe them with our flea and tick shampoo at your expense.
Spaying/Neutering
All dogs older than 6 months must be spayed or neutered.
Feeding and Medication
We feed pets in our care in the morning and in the evening. If your pet requires a special feeding protocol, instructions must be provided when the pet is presented for service at Rex & Roxy’s. We will medicate your pet per your instructions at no charge, but will not administer insulin shots. All medications must be in original packaging with original dosing instruction label from the veterinarian. Overly complicated or excessive medication may result in an additional charge.
Reservations for Overnight Stays
Sleepover space is limited, and reservations are strongly recommended. Please notify us as soon as possible of any change of plans. During major holidays and Masters, we require a deposit, which is non-refundable unless you cancel before the specified due date. In addition, once your stay is confirmed you will be obligated to pay for the entire time reserved, even if you drop off late or pick up early, unless we are able to re-book the room. We provide bedding, bowls, and toys to all boarders. Personal items are not guaranteed to be returned.
Sick Pets
We reserve the right to refuse a visit if your pet arrives sick, not up to date on vaccinations, or with a flea, tick, or ear mite condition. If a pet gets sick or injured while here, our contact order is the dog’s owner, listed contacts, the owners vet, and finally an emergency vet, should we deem it necessary.
Pick-Up
Please be prompt about picking up your dog at the end of the day, and please call us if you are running late. We reserve the right to assess a late fee if we have to wait for you.

Your Information

Others Who May Pick Up Your Pet

Vet Information

Emergency Contact (other than vet)

Temperament Test

Vaccinations

Flea Control

Spaying/Neutering

Feeding and Medication

Reservations for Overnight Stays

Sick Pets

Pick-Up

Adventures In Doggie Playcare!

Our Address

Phone & Email

Our Hours