[smartslider3 slider=41] Doggie DNR Form Please fill out completely and accurately. Dog Name*Enter your Dog's name. Dog Breed*Enter your breed of Dog.Mixed Breed - GiantMixed Breed - LargeMixed Breed - MediumMixed Breed - ToyMixed Breed -SmallAffenpinscherAfghan HoundAfrican BoerboelsAiredale TerrierAkbashAkitaAlapaha Blue Blood BulldogsAlaskan Klee KaiAlaskan MalamuteAmerican BulldogAmerican Eskimo DogAmerican FoxhoundAmerican Staffordshire TerrierAmerican Water SpanielAnatolian Shepherd DogAustralian Cattle DogAustralian KelpieAustralian ShepherdAustralian Silky TerrierAustralian TerrierBasenjiBasset HoundBeagleBearded CollieBeauceronBedlington TerrierBelgian MalinoisBelgian Shepherd DogBelgian TervurenBernese Mountain DogBichon FriseBlack and Tan CoonhoundBlack Russian TerrierBloodhoundBorder CollieBorder TerrierBorzoiBoston TerrierBouvier des FlandresBoxerBriardBrittanyBrussels GriffonBull TerrierBullmastiffCairn TerrierCanaan DogCardigan Welsh CorgiCarolina DogCatahoula Leopard DogsCavalier King Charles SpanielCentral Asian OvtcharkasCesky TerrierChesapeake Bay RetrieverChihuahuaChinese CrestedChinese FooChinese Shar-PeiChipooChow ChowClumber SpanielCocker SpanielCollieDachshundDalmatianDandie Dinmont TerrierDoberman PinscherDogue de BordeauxEnglish BulldogsEnglish Cocker SpanielsEnglish FoxhoundEnglish SetterEnglish ShepherdEnglish Springer SpanielEnglish Toy SpanielEstrela Mountain DogsField SpanielFinnish SpitzFlat-Coated RetrieverFox Terrier (Smooth)Fox Terrier (Wire)French BulldogGerman PinscherGerman ShepherdGerman Shorthaired PointerGerman Wirehaired PointerGiant SchnauzerGlen of Imaal TerrierGolden RetrieverGoldendoodleGordon SetterGreat DaneGreat PyreneesGreater Swiss Mountain DogGreyhoundHarrierHavaneseHungarian VizslaIbizan HoundIrish SetterIrish TerrierIrish Water SpanielIrish WolfhoundItalian GreyhoundJack Russell TerrierJapanese ChinKeeshondKerry Blue TerrierKomondorKooikerhondjeKuvaszLabradoodleLabrador RetrieverLaekenoisLakeland TerrierLancashire HeelerLhasa ApsoLöwchenMalteseMaltipooManchester TerrierMaremma SheepdogMastiffMiniature Bull TerrierMiniature PinscherMiniature PoodleMiniature SchnauzerNeapolitan MastiffNewfoundlandNorfolk TerrierNorwegian BuhundsNorwegian ElkhoundNorwich TerrierNova Scotia Duck Tolling RetrieverOld English SheepdogOtterhoundPapillonParson Russell TerrierPeekapooPekingesePembroke Welsh CorgiPetit Basset Griffon VendeenPharaoh HoundPit BullPlottPointerPolish Lowland SheepdogPomapooPomeranianPoodle (Minature)Poodle (Standard)Poodle (Toy)Portuguese Water DogPugPuliRat TerrierRedbone CoonhoundRhodesian RidgebackRottweilerSaint BernardSalukiSamoyedSchipperkeSchnoodleScottish DeerhoundScottish TerrierSealyham TerrierShetland SheepdogShiba InuShih TzuSiberian HuskySilky TerrierSkye TerrierSnorkieSoft-coated Wheaten TerrierSpinone ItalianoStaffordshire Bull TerrierStandard SchnauzerSussex SpanielSwedish VallhundThai RidgebackTibetan MastiffTibetan SpanielTibetan TerrierToy Fox TerrierToy Manchester TerrierToy PoodleTreeing Walker CoonhoundVizslaWeimaranerWelsh Springer SpanielWelsh TerrierWest Highland White TerrierWhippetWirehaired Pointing GriffonXoloitzcuintleYorkie-PooYorkshire TerrierSex*Sex of Dog.MaleFemaleDog's Birthday.Enter Dog's Birthday if you know it. (If not leave blank) MM slash DD slash YYYY Dog's Age.*Enter Dog's age. Pet Microchip Number.Enter Dog's Micro Chip Number. Pet Insurance CompanyIf you have Pet Insurance enter who it is with. (If none leave blank) Pet Insurance Phone NumberIf you have Pet Insurance enter the phone number. (If none leave blank)Medical HistoryEnter your Dog's Medical history if any.Medications/AllergiesEnter any Medications your dog may be taking or any specific Allergies.Special Instructions.Enter any special instructions you may have. (May be used for specific instructions in regards to your dog, guidance on medication, how much and when to give).Dog Photo.*Upload current photo of your Dog. MAKE Sure the photo is oriented correctly! (Smartphones support what's known as EXIF image data which includes an orientation option) Save the image upright prior to uploading!Accepted file types: jpg, gif, png, Max. file size: 32 MB.Owner's Name*Dog owner's name First Last Owner's NameAdditional Owner's Name First Last Owner's Address*Owner's Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Owner's phone numberOwner's Email*Owner's Email address. Dog's Veterinarian Clinic.Dogs Veterinarian Office/Clinic Veterinarian.Who is the Dog's Veterinarian? Veterinarian Address.Enter the Dog's Veterinarian's address. Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Veterinarian Phone.Enter Dog's Veterinarian's phone number.Doggie Day Care/Sitter Business.Enter your Pet Sitter/Doggie Day Care business name. Doggie Day Care/Sitter Contact.Enter Contact person- Pet Sitter/Doggie Day Care. Doggie Day Care/Sitter Phone.Enter the Doggie Day Care/ Pet Sitters phone number.Doggie Day Care/Pet Sitter Email.Enter the Doggie Day Care/ Pet Sitters email address. (if none leave blank) Box A - CPR*Do you want your Dog to receive CPR. (Cardiopulmonary Resuscitation) Dog has no pulse and not breathing. Yes CPR - Attempt resuscitation/CPRNo CPR - Do not resuscitate/DNR/ Allow natural death.Box B - MEDICAL INTERVENTIONS (Dog has pulse and/or is breathing)*Choose one of the following: 1. Comfort measures only: (Use medication by any route, positioning, and any other measures to relieve pain and suffering including Oxygen, Suction and manual treatment of airway obstruction as needed for comfort. Do not transport to the Veterinarian for life sustaining treatment.) 2. Limited Additional Interventions: (Use medical treatment, IV, fluids and cardiac monitor as indicated. Do not use intubation, advanced airway interventions, mechanical ventilations. Transfer dog to the Veterinarian.) 3. Full Treatment: (Include care as described above. Use intubation, advanced airway interventions, mechanical ventilation, and cardioversion as indicated. Transfer dog to the Veterinarian.)Comfort measures only.Limited Additional Interventions.Full Treatment.Box C -ANTIBIOTICS*Choose one of the following: 1. No antibiotics (Use other measures to relieve symptoms.) 2. Use antibiotics.No antibiotics - Use other measures to relieve symptoms.Use antibiotics.BOX D - ARTIFICIALLY ADMINISTERED NUTRITION AND HYDRATION.*Choose one of the following: 1. No artificial nutrition/hydration by tube. 2. Use artificial nutrition/hydration.No artificial nutrition/hydration by tube.Use artificial nutrition/hydration.Liability Acknowledgment.*By clicking yes you fully understand that This Doggie DNR has no legal binding and you should consult with your Veterinarian before using this from.Yes - I Understand Δ