Pet Mobile Services consent form | Freshfields Animal Rescue

Welcome to Freshfields Animal Rescue Petmobile Service. We are here to help keep pets and their people together and will do all we can to help you and your pet.

Before we see you we need you to complete this form

Name

Select

Street Address

City

State/Province

ZIP / Postal Code

Email Address

Phone

What animal would you like to talk to us about?DogCatRabbitOther

What breed ?Please provide breed of dog/cat/rabbit/other

Is the animal yours?Are you the owner/registered keeper?YesNo

How long have you owned the pet?

Is your pet microchipped?YesNoDon't know

What help would you like to talk to us about?Please tick all boxes that applyBehaviour and trainingMicrochip and updateNeuteringHelp with a strayHelp with emergency vet billPet general costsLandlord issuePersonal issues (health/personal circumstances)Pets healthFlea/worm treatmentGroomingPet food & SuppliesOther

If other please provide details

Before we see you, we need you to complete this disclaimer and consent form. Please tick the box to confirm your consent then sign below. If you have any questions please ask a member of staff. Disclaimer Freshfields is committed to providing the highest standard of care and attention to your pet. Please note the following: Behavioural Support: Any behavioural advice, training, or handling techniques provided are based on our professional knowledge and experience. However, individual results may vary depending on the animal’s history, temperament, environment, and consistency of training at home. No guarantee of outcome or resolution of behavioural issues can be given. Health Checks & Nursing Procedures: Services such as nail clipping, ear cleaning, anal gland expression, microchipping, parasite treatments, and other non-diagnostic health checks are carried out with care and in accordance with our professional training. These procedures are intended as supportive care and do not replace a full veterinary examination or treatment by a licensed veterinarian. Veterinary Responsibility: If, during any procedure, we identify a potential health concern, you will be advised to seek veterinary attention. We do not diagnose, prescribe, or perform veterinary surgery from the Petmobile. • Previous Veterinary History: If your pet requires veterinary treatment or surgical procedures through Freshfields, you agree to provide consent for us to request and review your pet’s previous veterinary history from your registered veterinary practice. This information is essential to ensure safe and appropriate care. Failure to provide consent may result in delays or an inability to proceed with treatment. • Post-Procedure & Emergency Care: Freshfields Animal Rescue is not a 24-hour or emergency veterinary service and does not have the facilities or staffing to provide ongoing or out-of-hours care. In the event of any complications following a procedure or surgery, you must contact your registered veterinary practice or the nearest available veterinary provider immediately. By using our service, you acknowledge and accept that responsibility for follow-up and emergency care rests with you and your chosen veterinary provider.Risk Acknowledgement (Pets & People): While every effort is made to minimise stress, discomfort, or risk of injury, there is always the possibility of unexpected reactions (e.g. anxiety, aggression, minor bleeding, bruising, allergic reaction, or infection). By consenting to these services, you acknowledge and accept these risks. Please also be aware that handling animals always carries some risk to people (e.g. scratches, bites, or other injuries), and while precautions are taken, we cannot be held liable for injuries sustained during appointments. Owner Responsibility: It is your responsibility to disclose any known medical conditions, injuries, or behavioural concerns of your pet before treatment. Ongoing veterinary care remains the responsibility of the pet’s registered veterinarian. You remain legally responsible for the control of your pet at all times. Data protection In accordance with UK GDPR and the Data Protection Act 2018, I agree that Freshfields Animal Rescue may hold and use personal information provided by me, for the purposes of receiving a service from the Freshfields Animal Rescue Petmobile. This information will be held securely and only accessed by authorised personnel. I consent to Freshfields processing my data including any sensitive data (such as data relating to health) for the above purposes. For information about how we hold, use and protect your data visit www.freshfields.org.uk/privacy-policy

We would like to keep you informed of news, events and the vital work we do. Please confirm, by ticking in the box, if you are happy with us to contact you byEmailMailPhone

Consent *

By visiting the Petmobile service, I confirm my understanding and acceptance of these terms and conditions.

Signature

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