Please Complete One Pet Information Disclosure Form Per Pet.

Owner First Name:
Owner Last Name:
Email:
Pet Name:
Sex :	Male Female
Pet Type :	Dog Cat Bird Other
If, other - please list type:
Breed:
Declawed :	Yes No
Neutered :	Yes No
Birth date :
Age :
Weight :
Size :
Length of Time Owned:

Physical Description (if similar to another):

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Feeding Instructions (hold down "ctrl" key for multiple choices):      Feed apart from other pets/supervise Dispose of uneaten food Remove food after ____ Min

If, Remove food after ____ Min. How many minutes?:

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Pet Food

Brand (dry):
Measure with:
Amount:
Where to feed:
Procedure:

When to feed (hold down "ctrl" key for multiple choices):

Morning Afternoon Dusk Night

Brand (wet):
Measure with:
Amount:
Where to feed:
Procedure:

When to feed (hold down "ctrl" key for multiple choices):

Morning Afternoon Dusk Night

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Medication

Medication Brand/Type:
Dosage:
Time of Dosage:
Location of Medication:
Hide In Treat:
Procedure:

Time of Day (hold down "ctrl" key for multiple choices):

Morning Afternoon Dusk Night

Medication Brand/Type:
Dosage:
Time of Dosage:
Location of Medication:
Hide In Treat:
Procedure:

Time of Day (hold down "ctrl" key for multiple choices):

Morning Afternoon Dusk Night

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Water will be cleaned and filled frequently

Water:	Tap Bottled Filtered
Dish Location:
Water Location:

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Treats

Name:
Amount:
Location:
Notes:

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Pets Living Area (hold down "ctrl" key for multiple choices):

     NOT allowed outdoors at all ONLY allowed outdoors on leash Turn out, invisible fenced yard with collar Turn out, secure fence Turn out, no fence, but doesn't leave yard NOT allowed indoors Allowed on furniture, counters, beds Restrict pet area/crate only when pet is alone Restrict pet area/crate at all times

Restricted Area/Crate Location:
Other off-limit areas :

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Emergency Care: *Placing Credit Card on file at vets office is recommended

Vet Name:
Clinic Name:
Address:
Phone:
Pet Allergies :
Heartworm test :	Negative Positive

Vaccinations up to date on (month/yr) :

Pet Medical History: (ongoing or reoccurring known illnesses/injuries, treatments & medications):

Pets will be taken to the nearest emergency facility in the event of life threatening or injury where time is a factored critical element. For your protection and ours, we require all pets be current on vaccinations. A copy of this record will need to be provided. While in the care of Arlene Ruiz and/or SPOIL’D ROTT’N, all animals are required to wear identification tags.

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Pet Doesn't Like (hold down :

     Baths Hot Days Sharing Food Dishes Toenail Clip Rain / Snow / Cold Loud Noise / Vacuum / Garbage Disposal / Thunder Massage New Animals All Humans Touch Ears Other family pets Strangers Sprays People near food dish Other

List other dislikes below;:

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Has Pet Ever Attacked Someone/Bit Someone?	Yes No
Has Pet Ever Attacked Another Animal?	Yes No
Has Pet Ever Injured Self /Escaped Out Of Fear?	Yes No
Has Pet Ever Injured Self Out Of Boredom?	Yes No

Describe (even if mild, or under extreme/unusual situations):

Has Pet Ever Escaped From Home?	Yes No
Where does he/she like to escape to?
How can he/she be retrieved?

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Commands:

Sit:	Knows Working On Doesn't Know
No:	Knows Working On Doesn't Know
Outside:	Knows Working On Doesn't Know
Make Poo:	Knows Working On Doesn't Know
Potty:	Knows Working On Doesn't Know
Bad:	Knows Working On Doesn't Know
Bath :	Knows Working On Doesn't Know
In the House:	Knows Working On Doesn't Know
Stay:	Knows Working On Doesn't Know
Down:	Knows Working On Doesn't Know
Walk:	Knows Working On Doesn't Know
Food:	Knows Working On Doesn't Know
Who's Here:	Knows Working On Doesn't Know
Good:	Knows Working On Doesn't Know
Move:	Knows Working On Doesn't Know
Ride:	Knows Working On Doesn't Know
Come:	Knows Working On Doesn't Know
Lay:	Knows Working On Doesn't Know
Don't Pull:	Knows Working On Doesn't Know
Treat:	Knows Working On Doesn't Know
Back:	Knows Working On Doesn't Know
Drop [it]:	Knows Working On Doesn't Know
Come-on:	Knows Working On Doesn't Know
Heal:	Knows Working On Doesn't Know
Out:	Knows Working On Doesn't Know
Walk Nice:	Knows Working On Doesn't Know
Cookie:	Knows Working On Doesn't Know
Naughty:	Knows Working On Doesn't Know
Don't Touch:	Knows Working On Doesn't Know
Off:	Knows Working On Doesn't Know

Favorite Games, Toys, and Activities:

Comments:

We will have you sign the printed form during our meeting before service begins.