“The Right Steps & Cindy C. Smith”

Pet Information Form

Pet Name: ____________________________________  □ Cat   □ Dog  □ Bird  □ Other ____________________________________

Sex:         □  Female     Spayed?  □ No  □Yes                                    □  Male     Neutered?  □ No  □Yes

Color: ______________________________________________________________________________________________________

Breed: _____________________________________________ Pet’s Date of Birth: ________________________________________

   Pet’s Weight: ____________________________________________

Feeding Instructions:

A.M. _______________________________________________________________________________________________________

P.M. _______________________________________________________________________________________________________

Brand of Pet Food Used: _______________________________________________________________________________________

Medications: _________________________________________________________________________________________________

                                Name of Medication                               When to Administer Medication                            Amount                   How to Administer

       _________________________________________________________________________________________________

                                Name of Medication                               When to Administer Medication                            Amount                   How to Administer

Daily exercise to be given: □ Yes □ No                                            FOR OFFICE USE ONLY ~ Verified vaccination records (date)

Rabies shot good through (date) _________________________________________________________________________________

DHLPP shot good through (date) ________________________________________________________________________________

History of illness?  □ Yes □ No         If yes, explain: __________________________________________________________________

____________________________________________________________________________________________________________

Pet’s collar color: _____________________________________________       ID Tags: □ Yes □ No

Favorite toys and special treats: __________________________________________________________________________________

May pet sitter give your pet treats? □ Yes □ No

Personality (include phobias/fears) _______________________________________________________________________________

____________________________________________________________________________________________________________

Has your pet ever snapped at our bitten anyone?  □ Yes □ No                                                   Is your pet good with children? □ Yes □ No

Does your pet have a history of biting or fighting with other animals?  □ Yes □ No               Can you groom your pet?  □ Yes □ No

Are you aware of any reason we should approach your pet with caution? _________________________________________________

How does your pet react to your absence from home? ________________________________________________________________

Dollar limit on emergency care: $ ______________________

Name of Owner: _______________________________   Signature: ______________________________  Date: ______________

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