Pet Profile

Is your pet on flea and tick preventatives?*

YesNo

If you answered "Yes" above, please list which flea and tick preventative your pet uses:*

Is your pet on heartworm prevention?*

YesNo

If you answered "Yes" above, please list the heartworm preventative your pet uses:*

Is your pet up-to-date on their rabies vaccination?*

YesNo

Is your pet up-to-date on all age-appropriate vaccinations?*

YesNo

If you answered "No" to the previous question, please indicate the reason for your pet's current vaccination status:

Please upload all current vaccination records here including current rabies certificate. PLEASE NOTE THAT A RABIES TAG IS NOT ACCEPTED AS PROOF OF VACCINATION. PLEASE ONLY PROVIDE THE RABIES CERTIFICATE FROM A LICENSED VETERINARIAN:*

Please note that vaccination records, including current valid rabies certificates, are required in order for us to ensure proper and safe care for your pet(s).

Is your pet Microchipped?*

YesNo

If microchipped, how many digits are contained within your pet's specific microchip ID number?*

91015

If you answered "Yes" to your pet being microchipped, please provide your pet's microchip ID (PLEASE CAREFULLY REVIEW YOUR ENTRY FOR ACCURACY):*

A microchip ID should consist of 9, 10, or 15-digits with no spaces or punctuation. Please carefully review your entry so as to ensure the correct ID is provided.

If you answered "Yes" to your pet being microchipped, please provide your pet's microchip ID (PLEASE CAREFULLY REVIEW YOUR ENTRY FOR ACCURACY):*

A microchip ID should consist of 9, 10, or 15-digits with no spaces or punctuation. Please carefully review your entry so as to ensure the correct ID is provided.

If you answered "Yes" to your pet being microchipped, please provide your pet's microchip ID (PLEASE CAREFULLY REVIEW YOUR ENTRY FOR ACCURACY):*

A microchip ID should consist of 9, 10, or 15-digits with no spaces or punctuation. Please carefully review your entry so as to ensure the correct ID is provided.

Microchip Registry:*

Please check your pet's microchip registry annually to ensure all information is accurate and current. 25-40% of microchipped pets have inaccurate or incomplete information within their microchip registry, which significantly increases the risk of a lost pet not being returned home (UP TO 5X LESS LIKELY TO BE RETURNED HOME).

Does your pet require medications?*

YesNo

Medications*

Medication #1*

Location where Medication is stored*

Medication times*

Directions*

If your pet has more than one medication please list the additional medications and instructions here. If you pet does not require additional medications, but you wish to provide further information regarding a single medication, please use the space provided below:*

Has your pet been diagnosed with allergies?*

YesNo

If "Yes", please list what type of allergies below.*

What symptoms does your pet exhibit with their allergies?*

Has your pet had any previous illnesses, injuries, or surgeries we should be aware of?*

YesNoUnknown

If "Yes" please explain in detail including whether those illnesses, injuries, or surgeries caused any lingering effects we should be aware of.*

Knowing whether old injuries flare up is crucial to us determining whether to seek veterinary care. Not knowing what is normal behavior of your pet can lead to unnecessary medical bills for you.

Please describe in detail your pet's car riding behavior. In the event we need to transport your pet, we must ensure the safety of your pet as well as ourselves.*

Burnell Pet Care and Education LLC

Basic Pet Information

Vaccination Records

Pet Profile

Feeding Instructions