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103 Clayton Dr Johnstown Pa 15904814-254-4021 JohnstownPetServices.com
Pet Information Disclosure
Please complete one Pet Information Disclosure form per pet
Owner:Pet Name:Length of time owned:Pet type: Cat/Dog/_________ Breed:Sex: M/F Declawed: Y/N Neutered/Spayed: YPhysical discription (if similar to anotheDate of Birth: Or age:Weight:Or size:
Feeding Instructions:
Brand:Procedure:Measure with:Amount:Where to feed:Brand:Procedure:Measure with:Amount:Where to feed:Procedure:Amount:Location:Hide in treat:Procedure:Amount:Location:Hide in treat:Fresh water will Dish location:be provided ateach visitWater location:Name:Notes:Amount:Location:
c
Feed apart from other pets/supervis
c
Dispose of uneaten food
c
Remove food after _____minutes
c
Dry
c
Morning
c
Afternoon
c
Dusk
c
Night
c
Wet
c
Morning
c
Afternoon
c
Dusk
c
Night
c
Medications
c
Morning
c
Afternoon
c
Dusk
c
Night
c
Medications
c
Morning
c
Afternoon
c
Dusk
c
Night
c
Water
c
Tap
c
Bottled
c
Filtered
c
Treats
Pg 1 of 3Owner:Pet:Pets Living AreaRestricted area/crate location:Other off limit locations:
Emergency Care:
Placing credit card on file at vets office is recommendedVet Name:Pet allergies:Clinic Name:Vaccinations up to date? (month/year):Phone:Heartwarm test: Negative/Positive
Temperament/Personality:
Pet doesn't like:
Pet reacts to the above by:
Has pet ever:
Describe (even if under extreme/unusual situations)
c
Not allowed outdoors at any time
c
Allowed on furniture, counters, bed
c
Only allowed outside on leash
c
Restrict pet area/crate when pet is alone
c
Restrict pet area/crate at all times
c
Let out, unsupervised, invisible fence yardwith collar
c
Let out, secure fence:
c
Let out, unsupervised, no fence, but doesn't le
c
Not allowed indoors
Pet Medical History:
(ongoing or reoccuring known illnesses/injuries, treatments, medication)
c
Bath
c
Strangers
c
Hot days
c
Sharing food dishes
c
Massage
c
Rain/snow/cold
c
Loud noises/vacuum/thunder/garbage disposal
c
Touch ears
c
New animals
c
All humans
c
Sprays
c
Other family pets
c
People near food dish
c
Attacked someone/bit someone
c
Attacked other animal
c
Injured self/escaped out of fear
c
Injured self out of boredem
c
Escaped from home
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