Pet Information Disclosure

Cozy Comforts Pets & More – Pet Information Disclosure

Please complete one Pet Information Disclosure form per pet

Owner:                                                                  Pet Name:
Length of Time Owned:                                Pet Type:   Dog / Cat / Horse /
Breed:                                                      Sex: M/F        De-clawed: Y/N     Neutered: Y/ N
License #:                                            Microchip/Tattoo/Dog Tag   #:
Physical Description (if similar to another):   Birth date:                          Or Age:
                                                         Weight:                           Or Size:

Feeding Instructions:

Feed apart from other pets/supervise     Dispose of uneaten food     Remove food after ____ Min

Dry              Brand:
Measure with:
Amount:
Where to feed:       Morning
Afternoon
Dusk
Night   Procedure:
Wet             Brand:
Measure with:
Amount:
Where to feed:       Morning
Afternoon
Dusk
Night   Procedure:
Medication(s):
Amt:
Location:
Hide In Treat:       Morning
Afternoon
Dusk
Night   Procedure:
Medication(s):
Amt:
Location:
Hide In Treat:       Morning
Afternoon
Dusk
Night   Procedure:
Water
   Water will be cleaned and filled frequently   Tap
Bottled
Filtered    Dish Location:

Water Location:
Treats         Name:
Amt:
Location:       Notes:

Pet’s Living Area:

NOT allowed outdoors at all
ONLY allowed outdoors on leash

Turn out, invisible fenced yard with collar
Turn out, secure fence: _________________
Turn out, no fence, but doesn’t leave yard

NOT allowed indoors   Allowed on furniture, counters, beds
Restrict pet area/crate only when pet is alone
Restrict pet area/crate at all times

Restricted Area/Crate Location:

Other off-limit areas:

                       Owner:                           Pet:

Emergency Care:                 *Placing Credit Card on file at vets office is recommended
Vet Name:                                                      Pet Allergies:
Clinic Name:                                                  Vaccinations up to date on (month/yr):
Phone:                                                      Heart-worm test: Negative / Positive

Pet Medical History: (ongoing or reoccurring known illnesses/injuries, treatments & medications)

Temperament/Personality:
Pet Doesn’t Like:
Baths   Hot Days   Sharing Food Dishes
Toenail Clip   Rain / Snow / Cold   Loud Noise / Vacuum / Garbage Disposal / Thunder
Massage   New Animals   All Humans
Touch Ears   Other family pets     Strangers
Sprays   People near food dish

Pet reacts to the above by:

Has Pet Ever:   Describe (even if mild, or under extreme/unusual situations)
Attacked someone/bit someone
Attacked another animal
Injured self /escaped out of fear
Injured self out of boredom
Escaped from home,
       Where does he/she like to escape to?
       How can he/she be retrieved?

Commands: (Please circle commands we know, and underline commands we are working on):
   Sit   No   Outside   Make Poo   Potty   Bad    Bath   In the House
   Stay   Down    Walk   Food   Who’s Here   Good    Move   Ride
   Come   Lay   Don’t Pull   Treat   Back   Drop [it]   Come-on
   Heel   Out   Walk Nice   Cookie   Naughty   Don’t Touch   Off
Allowed to go for rides in sitter vehicle? Y / N         May play with sitter’s personal pet(s) for socialization? Y / N

Favorite Games, Toys, and Activities:

Comments:

Client/Owner Name:

Signature: _______________________________ Date: ____________