New Client Form
Preferred Petsitter
Your Name
*
First Name
Last Name
Your E-mail
*
Your Phone Number
*
Your Address
*
Emergency Contact (preferably someone local in case of emergency)
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Preferred Veterinarian
*
Preferred Veterinarian Phone Number
*
Please enter a valid phone number.
Number of pets to be cared for
*
One
Two
Three
Four or more
Service(s) you are interested in
*
Dog Walk
Home Visit / Check In
Daycare in a host's home
Petsitting overnight in a host's home
Housesitting overnight in client's home
Other (SEE BELOW)
If you selected "Other" please describe services you are requesting
Requested start date & time
*
Requested end date & time
*
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Next
Save
Your Pet's Information
1st Pet's Name
*
Type of Pet
*
Please Select
Dog
Cat
Pet's Breed
*
Pet's Sex
*
Please Select
Male
Female
Pet's Age
*
Pet's Weight
*
Pet's Color and Unique Markings
*
Is Pet Spayed or Neutered?
*
Please Select
Yes
No
Is Pet Micro-chipped?
*
Please Select
Yes
No
If yes, please provide Chip ID and Information
Vaccination History
Written proof of vaccinations must be provided for each pet prior to final acceptance of appointment
Date DHLP (Distemper, Lepto, Parvo Combo) Expires
Date Bordetella Expires
Date Rabies Expires
Is Pet Current on Heartworm Preventative?
*
Please Select
Yes
No
Is Pet Current on Flea Preventative?
*
Please Select
Yes
No
2nd Pet's Name
*
Type of Pet
*
Please Select
Dog
Cat
Pet's Breed
*
Pet's Sex
*
Please Select
Male
Female
Pet's Age
*
Pet's Weight
*
Pet's Color and Unique Markings
*
Is Pet Spayed or Neutered?
*
Please Select
Yes
No
Is Pet Micro-chipped?
*
Please Select
Yes
No
If yes, please provide Chip ID and Information
Vaccination History
Written proof of vaccinations must be provided for each pet prior to final acceptance of appointment
Date DHLP (Distemper, Lepto, Parvo Combo) Expires
Date Bordetella Expires
Date Rabies Expires
Is Pet Current on Heartworm Preventative?
*
Please Select
Yes
No
Is Pet Current on Flea Preventative?
*
Please Select
Yes
No
3rd Pet's Name
*
Type of Pet
*
Please Select
Dog
Cat
Pet's Breed
*
Pet's Sex
*
Please Select
Male
Female
Pet's Age
*
Pet's Weight
*
Pet's Color and Unique Markings
*
Is Pet Spayed or Neutered?
*
Please Select
Yes
No
Is Pet Micro-chipped?
*
Please Select
Yes
No
If yes, please provide Chip ID and Information
Vaccination History
Written proof of vaccinations must be provided for each pet prior to final acceptance of appointment
Date DHLP (Distemper, Lepto, Parvo Combo) Expires
Date Bordetella Expires
Date Rabies Expires
Is Pet Current on Heartworm Preventative?
*
Please Select
Yes
No
Is Pet Current on Flea Preventative?
*
Please Select
Yes
No
Back
Next
Save
Walking/Bathroom Schedule
Where does your pet sleep?
What length of time is your pet ok being left alone?
Comments / Additional Information
Pet Care and Feeding Instructions
Will your request involve us feeding your pet?
Please Select
Yes
No
Food and Acceptable Treats you allow
*
Feeding Times and Amounts
*
Will your request involve us administering medications to your pet?
Please Select
Yes
No
How do you administer medication?
*
Medication Times and Amounts
*
File Upload
Browse Files
Drag and drop files here
Choose a file
Please upload written proof of vaccinations for your pet and a picture (or two)!
Cancel
of
Signature
*
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