Pet Care Intake Application

Nocturne Pet Care Co.

Pet Information Form
If you have multiple pets - Please fill out one additional form per additional pet.
Client Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Pet Photo For Pet Profile*

Cancelof
Pet Name:*
Breed and or Type:*
Species*

CanineFelineBirdReptile/AmphibianSmall MammalChickensGoatHorseOther
Approximate Age (include months if under 2 years old)*
Sex:*

MaleFemale
Spayed or Neutered:*

YesNoNo - my pet is too young at the time of completetionNot applicable due to the species of my pet.
Color:*
Please provide us with deatiled directions to feed your pet. Please be as detailed as possible.
Feeding Instructions
Location of where pets eat: *
Does your pet eat dry food?*

YesNoOther
What time(s) of day is your pet fed their DRY FOOD. Please check all that apply.

Not applicable5:00am to 8:00am8:00am to 11:00am11:00am to 2:00pm2:00pm to 5:00pm8:00pm to 11:00pmOther
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?*

YesNoOther
What time(s) of day is your pet fed their WET FOOD. Please check all that apply.

Not applicable5:00am to 8:00am8:00am to 11:00am11:00am to 2:00pm2:00pm to 5:00pm8:00pm to 11:00pmOther
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?*

YesNo
Please describe the routine in detail below.
Does your pet require any of the following when eating? Check all that apply.*

Not ApplicableFeed apart from other petsSupervise while eatingRemove food after so much timeDispose of uneaten food
If required please specify how much time is needed before removing food
Please give any additional detailed instructions on how to feed your pet.*
Please specify the type of water your provide for your pet.*

TapFiltered from refrigerator dispenserFiltered from pitcher in refrigeratorFiltered from sinkBottled
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? *

YesNo
If Yes please indicate how much water to provide at each refill
Please give any additional detailed instructions for water*
If this question does not apply to your pet please type N/A.
Does your pet receive treats?*

YesNo
Please indicate how many treats your pet can receive PER VISIT.

1/2 to 1 treat1-2 treats3-4 treatsNo limitOther
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 petsSupervise while eating treatRemove treat after so much timeDispose of uneaten treatNot Applicable
Please give any additional detailed instructions for treats
Does your pet receive medications? No need to include monthly preventative medications.*

YesNo
Medication #1
Location where Medication is stored
Medication times
Directions
Additional Information
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 visitsPlease walk my pet at least three times per day, otherwise, please take them out for a quick pee walk or let them out in the fenced yard.Please walk my pet at least two times per day, otherwise, please take them out for a quick pee walk or let them out in the fenced yard.Please walk my pet at least one time per day, otherwise, please take them out for a quick pee walk or let them out in the fenced yard.Please let my pet into the fenced yard. No walks are required.My pet is NOT allowed outside. They use a litter box or potty padMy 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
Does your cat use a litter box or dog use potty pads?

YesNo
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 ApplicableOnce every other dayOnce per dayTwice per dayThree times per dayFour times per dayEverytime the potty pad is soiled
Is this paperwork for a bird or small caged pet? If so please let us know how often we need to clean their cage and the directions to do so.
Is this paperwork for any other type of pet? If so please let us know any additional details we need to know to clean up after their waste.
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 RubsCuddleGive kissesFetchTug-o-warChaseWalkRun/JogPlay with toysMy pet does not play games or activitiesOther
Does your pet play with toys?*

YesNo
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 wordsSitStayLay DownWaitSlow DownEasyDon't Pull or No PullHeelNoLeave itDrop ItCome or Come HereOutside or Lets go OutsideGo PoopGo Potty or Go PeeDo your businessLets go Inside or InsideOffDown or Get DownWalk or Let's go for a WalkFoodTreatAre you hungry?CookieDo you want to eat?Who is here?Who is at the door?Ride or Do you want to go for a ride?I'll be backOther
Please add any additional commands your pet knows and how they're used.
Is you pet crated or placed in a restricted area when no one is home?*

YesNo
Please let us know your pet's living situation below. Please note that we will not take pets outside off leash unless inside a secured fence.*

Not allowed Outdoors at allKept Outside in fenced yard All DayKept Outside in fenced yard All NightKept Outside in fenced All Day & NightNot allowed Indoors at allNot allowed on furniture & bedsAllowed on furniture & bedsNot allowed on counters & tablesAllowed on counters & tablesRestrict pet area/crate All Day & All NightMy pet is not restricted and can have access to the entire houseOther
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.*

BathsHot daysSharing food dishesPeople or other pets near food dishPeople or other pets near treatsNail trimsRainColdLoud noiseVacuumThunderPetting rear endPetting near the headNew or strange animalsHumansTouching earsTouching paws or feetOther family petsStrangersFragrance spraysNone of the aboveOther
Please let us know any additional triggers and how your pet reacts to any of the above triggers.*
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 someoneAttacked and/or bit another animalEscaped from homeInjured self out of boredom/fearNot 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 bedHides behind or under couchHides under tablesHides in closetsRuns out doorsRuns upstairsNot ApplicableOther
Please describe any other hiding spots.
Please indicate how your pet can be 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?*

YesNo
If yes please explain in detail.
Did your pet have a previous illness or injury we should be aware of?*

YesNoUnknown
If yes please explain in detail.
Does your pet have any allergies?*

YesNo
If yes please list what they are allergic to and severity level 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.*

CalmRelaxedEasy GoingTrustingSweetLovingCuddlyHyperShyScaredTimidPushySuspicousAloofFearfulLazyJealousSpitefulHigh EnergyAnxiousReactive (Not Agressive)CuriousPlayfulPersistentSelectiveIndependentOther
This form was prepared by:*

First NameLast Name
Date*

MonthDayYear
Please use your mouse or finger to sign this document electronically.
Signature of person preparing form:*

Powered by Jotform SignClear
Should be Empty:

Nocturne Pet Care Co.

Please provide us with deatiled directions to feed your pet. Please be as detailed as possible.

Feeding Instructions