These Helping Hands
Pet Information Form
Client Name
*
First Name
Last Name
Client Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Veterinarian Name:
Veterinarian Contact Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Pet Name:
*
Breed:
*
Species
*
Canine
Feline
Approximately how old is your pet?
*
Puppy/Kitten
2+
5+
10+
Approximately how long have you owned your pet?
*
Is your pet up to date on vaccinations? (Proof may be required):
*
Yes
No
I'm Not Sure
Sex:
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Male
Female
Spayed or Neutered:
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Yes
No
No - my pet is too young at the time of completetion
Approximate Weight:
*
Color:
*
Please provide us with deatiled directions to feed your pet. Please be as detailed as possible.
Feeding Instructions
Location of where pet eats:
*
Does your pet eat dry food?
*
Yes
No
Other
Name of dry food:
*
Location of where dry food is stored:
*
Amount to feed pet EACH feeding:
*
Item used to measure food:
*
Does your pet eat wet food?
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Yes
No
Other
Brand of wet food:
*
Location where wet food is stored:
*
If this question does not apply to your pet please type N/A.
Amount of wet food to feed per feeding:
*
Location of extra dry food and/or wet food:
*
If this question does not apply to your pet please type N/A.
Location where food dishes are stored when not in use:
*
If this question does not apply to your pet please type N/A.
Location of extra food dishes:
*
If this question does not apply to your pet please type N/A.
Does the pet have a routine to follow before eating?
*
Yes
No
Please descibe the routine in detail below.
*
Does your pet require any of the following when eating? Check all that apply.
*
Not Applicable
Feed apart from other pets
Supervise while eating
Remove food after so much time
Dispose of uneaten food
Please specify how much time is needed before removing food
*
Please give detailed instructions on how to feed your pet.
*
Please speficy the type of water your provide for your pet.
*
Tap
Filtered from refridgerator dispenser
Filtered from pitcher in refridgerator
Filtered from sink
Bottled
Location of water dish
*
Water dishes will be refilled at each visit and cleaned 1x per day.
Is you pet restricted to a certain amount of water?
*
Yes
No
Please inidicate how much water to provide at each refill
*
Special instructions for water
*
If this question does not apply to your pet please type N/A.
Does your pet receive treats?
*
Yes
No
Please indicate how many treats your pet can recieve PER VISIT.
*
1/2 to 1 treat
1-2 treats
3-4 treats
No limit
Other
Location where treats are stored
*
If this question does not apply to your pet please type N/A.
When does your pet receive their treat?
*
Does your pet have a special routine to follow before getting a treat?
*
Does your pet require any of the following when receiving a treat?
*
Give treats apart from other pets
Supervise while eating treat
Remove treat after so much time
Dispose of uneaten treat
Not Applicable
Special instructions for treats
*
Does your pet receive medications? (No need to include monthly preventative medications)
*
Yes
No
Medication #1
*
Location where Medication is stored
*
Medication times
*
Directions
*
Additional Information
*
If this question does not apply to your pet please type N/A.
If your pet has more than one medications please list the additional medications and instructions here.
*
Does your pet require a walk at our visit(s)?
*
Please walk my pet at all visits
Please walk my pet at least three times per day, otherwise please let my pet in the fenced yard.
Please walk my pet at least two times per day, otherwise please let my pet in the fenced yard.
Please walk my pet at least one time per day, otherwise please let my pet in the fenced yard.
Please only let my pet into the fenced yard. No walks are required.
My pet is NOT allowed outside. They use a litter box or potty pad
My pet is an outdoor pet. No walks are necessary.
Where do you keep your pet's leash and/or collar?
*
Please indicate if we need to avoid specific houses or areas while walking.
*
Please indicate your pet's walking route.
*
Location of pet waste bags
*
Is your pet incontinent or known to have accidents?
*
Yes
No
Does your cat use a litter box or dog use potty pads?
Yes
No
Location of litter box or potty pad
Location of extra litter or extra potty pads
How often do you scoop your litter box or change out the soiled potty pads?
Not Applicable
Once every other day
Once per day
Twice per day
Three times per day
Four times per day
Everytime the potty pad is soiled
Where should we dispose of all pet waste?
*
Please let us know what games and or activities your pet likes to play and/or do.
*
Belly Rubs
Cuddle
Give kisses
Fetch
Tug-o-war
Chase
Walk
Run/Jog
Play with toys
My pet does NOT play games or activities
Other
Does your pet play with toys?
*
Yes
No
Location of toys:
Favorite Toys:
Please list the commands and words your pet knows, should know, or ones that you would like them to know.
*
My pet does not know any commands or words
Sit
Stay
No
Come or Come Here
Outside or Go Outside
Go Poop
Go Potty or Go Pee
Do your business
Bad or Bad Dog/Cat
Go in the House
Down or Get Down
Off
Walk or Let's go for a walk
Food
Treat
Are you hungry?
Do you want to eat?
Who is here?
Who is at the door?
Good or Good Dog/Cat
Move or Move over
Ride or Do you want to go for a ride?
Lay Down
Don't Pull of No Pull
Cookie
Drop It
Slow Down
Heel
Walk Nice
Naughty
Don't Touch
Leave it
Other
Is you pet crated or placed in a restricted area when no one is home?
*
Yes
No
Please let us know your pet's living situation below. Please note that Fuzzy Friends will not take pets outside off leash unless inside a secured fence.
*
NOT allowed outdoors at all
Kept Outside in fenced yard ALL DAY
Kept Outside in fenced yard ALL DAY
Kept Outside in fenced ALL DAY & NIGHT
NOT allowed indoors at all
Allowed on furniture & beds
Allowed on counters & tables
Restrict pet area/crate ALL DAY & ALL NIGHT
Restrict pet area/crate NIGHT ONLY
My pet is not restcited and can have access to the entire house
Other
Location of crate, gated off area, or fenced in yard
*
Please type N/A if this question does not apply.
Please let us know which of the following does your pet NOT like.
*
Baths
Hot Days
Sharing Food Dishes
People or other pets near food dish
People or other pets near treats
Nail trims
Rain
Cold
Loud Noise
Vacuum
Thunder
Petting Hind End
Petting near the head
New or Strange Animals
Humans
Touching Ears
Touching Feet
Other family pets
Strangers
Fragrance Sprays
None of the above
Other
Please let us know how your pet reacts to any of the above.
*
If this question does not apply to your pet please type N/A.
Has your pet ever done any of the following?
*
Attacked and/or bit someone
Attacked and/or bit another animal
Escaped from home
Injured self out of boredom/fear
Not Applicable
Please describe the incident(s) even if mild or under extreme or unusual circumstances
*
If this question does not apply to your pet please type N/A.
Where does your pet like to escape or hide?
*
Hides behind or under bed
Hides behind or under couch
Hides under tables
Hides in closets
Runs out doors
Runs upstairs
Not Applicable
Other
Please indicate how your pet can retrieved.
*
If this question does not apply to your pet please type N/A.
Does your pet have any ongoing or reoccurring known illnesses and/or injuries? Is your pet undergoing any medical treatments?
*
Yes
No
If yes please explain in detail.
Did your pet have a previous illness or injury we should be aware of?
*
Yes
No
Unknown
If yes please explain in detail.
*
Has your pet been diagnosed with allergies?
*
Yes
No
If yes please list what type pf allergies below.
*
What type of symptoms does your pet exhibit when their allergies flare up?
*
Please let us know what temperament and personality describes your pet. Check all that apply.
*
Calm
Sweet
Loving
Cuddly
Agressive
Hyper
Shy
Scared
Timid
Relaxed
Easy Going
Pushy
Suspicous
Aloof
Fearful
Lazy
Jealous
Trusting
Spiteful
Crazy
Other
This form was prepared by:
*
First Name
Last Name
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