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
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
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
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
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
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
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