Dog Information Form

Dog Information Form
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Complete one Pet Information Disclosure form per pet or litter.
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number
E-mail
Pet Name
Length of Time owned
Breed
Neutered

Yes No
Physical Description
Weight/Size
Dog License Number
Age / Birthday
Feeding Instructions
Do any of the following apply?

Feed apart from other pets / supervise Dispose of uneaten food Remove food after a certain amount of time (please note time in "other") Other option
Dry food brand
Wet food brand
What do you use to measure food?
How much do you feed your dog?
Where do you feed your dog and what location?
Please explain the times of day you feed your dog and any special procedures.
Please explain any medication(s) your dog is on, the amount, location, and how it's given.
What type of water? (cleaned and filled frequently)

Tap Bottled Filtered Other option
What treats do you give your dog? Where are they located? Please note any special instructions.
Pet living area
Select all that apply

Not allowed outdoors at all Only allowed outdoors on leash Allowed outside, invisible fenced yard and collar. Allowed outside, no fence, but doesn't leave yard. Allowed outside, has fence. Allowed on furniture and beds. Restrict pet area/crate when dog is alone. Restrict pet area/create at all times. Other option
Restricted pet area / crate location
Emergency Care

*Placing credit card on file at vets office is recommended
Vet Name
Clinic Name
Phone Number

- Area Code Phone Number
Pet Allergies
Vaccinations up to date on (month/year)
Heartworm test

Negative Positive
Pet Medical History (ongoing or reoccuring known illnesses/injuries, treatments & medications)
Temperament and Personality
Pet does not like (select all that apply)

Baths Toenail Clip Massage Touch ears Sprays Hot Days Rain/Snow/Cold New animals Other family pets People near food dish Sharing food dishes Loud noise/vacuum/garbage disposal/thunder Strangers All humans
Pet reacts to the above by
Has pet ever (select all that apply) Describe, even if mild, or under extreme/unusual situations

Attacked or bitten someone Attacked another animal Inured self/escaped from fear Injured self out of boredom Escaped from home Other option
Where has the pet like to escape to? How can he/she be retrieved?
Special instructions
Commands (select all that apply)

Site Stay Move Back Naughty No Down Ride Drop (it) Don't touch Outside Walk Come Come-on Off Potty Food Lay Heel out Bath Who's here Don't pull Walk nice In the house Good boy/girl Treat Cookie Other option
Please attach picture
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Dog Information Form

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Feeding Instructions

Pet living area

Emergency Care

Temperament and Personality