Stuffed Animal Clinic Checklist Form
Please fill out this form to check in your stuffed animal for clinic repair, cleaning, or treatment. All fields are required for intake.
Stuffed Animal Name or Identifier
*
Type/Species of Stuffed Animal
*
How long have you owned this stuffed animal?
*
Describe the appearance (color, size, unique features)
*
Current Condition or Issues
*
Requested Service
*
Repair
Cleaning
General Check-up
Other
Date and Time of Intake
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Upload a Photo of the Stuffed Animal (optional but helpful)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Owner's Full Name
*
First Name
Last Name
Owner's Email Address
*
example@example.com
Submit Checklist
Should be Empty: