Dog Information Form
Complete one Pet Information Disclosure form per pet or litter.
Street Address Line 2
State / Province
Postal / Zip Code
Length of Time owned
Dog License Number
Age / Birthday
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")
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)
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.
Restricted pet area / crate location
*Placing credit card on file at vets office is recommended
Vaccinations up to date on (month/year)
Pet Medical History (ongoing or reoccuring known illnesses/injuries, treatments & medications)
Temperament and Personality
Pet does not like (select all that apply)
Other family pets
People near food dish
Sharing food dishes
Loud noise/vacuum/garbage disposal/thunder
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
Where has the pet like to escape to? How can he/she be retrieved?
Commands (select all that apply)
In the house
Please attach picture
Should be Empty: