Client Referral

We thank you for taking the time to make a difference in someone else’s life!

We encourage referrals from authorised persons like doctors, local vets, social workers, hospitals or ACAT representatives. However, if you do not have a referral from one of these services, you can still submit the form and someone will contact you for further information.

Please make sure that our email addresses have been added to your ‘safe sender’ list to make sure we don’t end up in your junk mail. Click here to find out how to add us to your list.

You can also call us on 1300 1100 92

Name*

First

Last
Address*

Street Address

City

State / Province / Region

ZIP / Postal Code
Best contact phone number*
Email*

Enter Email

Confirm Email
Emergency Contact name*

First

Last
Best contact phone number*
Relationship to client
How did you hear about us?
Select your general area*
Services Required*
- Dog Walking
- Animal Medication
- Transport
Select all that may apply
Age of person requiring assistance*
We encourage referrals from authorised persons like doctors, local vets, social workers, hospitals or ACAT representatives. Please enter the details and attach an official request letter below.

However, if you feel you could use any of our services and have not been referred by someone, please continue to submit this form and we will get in contact with you.
Name of referring person

ABC Vet Clinic; ACAT Armadale etc.
Name of referring organisation

ABC Vet Clinic; ACAT Armadale etc.
If more information is required for this referral, what is the best contact number:
Upload your request letter (accepted file formats: jpg, gif, png, pdf, tif, tiff, docx, doc)
Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, tif, tiff, docx, doc.
If you are unable to upload your request letter with this form submission, please click here to email your support letter to us with reference to the client name.
Tell us about your pet(s)
Name
Age
Breed
Good with other animals?
Good with children?
Current activity level

Choose how many walks per week the pet currently gets.
Desired activity level

How often would you like your pet to be walked per week?
Second pet?
Name
Age
Breed
Good with other animals?
Good with children?
Current activity level

Choose how many walks per week the pet currently gets.
Desired activity level

How often would you like your pet to be walked per week?
CAPTCHA
Name

This field is for validation purposes and should be left unchanged.

Tell us about your pet(s)