Name* First Last Phone*Email* Emergency Contact Name* First Last Emergency Contact Phone*Drop Off Date Requested* MM slash DD slash YYYY Pick Up Date Requested* MM slash DD slash YYYY Dates requested are not guaranteed & we'll be in touch soon to verify if your selected date range is available. Please allow 48 hours for processing & confirmation. Thank you!Patient Name*Species* Feline CanineBreed*Services requested:* VAX Bath/Nail Trim Anal Glands Expressed Other NoneOther*We feed Hill's Science Diet but do recommend bringing your pet's food to reduce potential upset stomach. Tell us, how much food do you feed your pet daily? (quantity & number of times per day, or free feed):*Reminders: Pet Lodge hours are: Monday- Friday 7:30am-5pm Sat- 8a-10a ( pets must be fully current on vaccines to drop off on a Sat.) Sunday pick-up only between 4pm-6pm No drop off or pick up on major holidaysSignature*Reset signature Signature locked. Reset to sign again PhoneThis field is for validation purposes and should be left unchanged.