PET INFORMATION SHEET

 

Name of owner:________________________________

Name of pet:__________________________________        Place your pet’s photo here

Species/breed:_________________________________

Sex:_________

Spayed/Neutered:______________________________

Birth date or approximate age:_____________________

Indoor or outdoor:______________________________

Color:_______________________________________

 

Other forms of identification or description (microchip, tattoo, identifying marks, etc.): ___________________________________________________________________________________

 

VETERINARY AND HEALTH INFORMATION

 

Name of Veterinarian/Clinic:______________________________________________________________

Address:_____________________________________________________________________________

Phone:____________________________________ Fax: _____________________________________

Location of veterinary records other than above facility:__________________________________________

Current medications and instructions:________________________________________________________

___________________________________________________________________________________

Other health considerations: (chronic illness, allergies, injuries): ____________________________________

___________________________________________________________________________________

 

CARETAKING INFORMATION

 

Name of temporarycaretaker or kennel:____________________________________________________

Address:____________________________________________________________________________

Phone:____________________________________ Fax: _____________________________________

 

Name of permanentcaretaker or kennel:____________________________________________________

Address:___________________________________________________________________________

Phone: ___________________________________ Fax: _____________________________________

 

Description of typical daily routine for the care of the pet:________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Accommodations (where the pet sleeps, where the pet stays during the day):_________________________

___________________________________________________________________________________

___________________________________________________________________________________

Diet (brand and type of food, instructions for mixing, feeding times): _______________________________

__________________________________________________________________________________

__________________________________________________________________________________

Recreational activities ( walks, games, favorite toys): __________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Persons, objects or circumstances that the pet does NOT like (men, women, children, loud noises, water, etc.)

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Circumstances that may cause the pet to bite:_________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Any behavioral problems (barking, chewing, separation anxiety, heel nipping): ________________________

___________________________________________________________________________________

___________________________________________________________________________________

OTHER DOCUMENTS RELEVANT TO PET CARE:

Type:                                                  Location:

_____Will                                                       _______________________________________________

_____Living Trust                                          _______________________________________________

_____Pet Trust                                               _______________________________________________

_____Durable Power of Attorney                  _______________________________________________

_____Healthcare Power of Attorney              _______________________________________________

_____Living Will                                           _______________________________________________

_____Contract for Care                                  _______________________________________________