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 _______________________________________________