103 Clayton Dr Johnstown Pa 15904

814-254-4021
JohnstownPetServices.com

Pet Information Disclosure

Please complete one Pet Information Disclosure form per pet

Owner: Pet Name:

Length of time owned: Pet type: Cat/Dog/_________
Breed: Sex: M/F Declawed: Y/N Neutered/Spayed: Y/N
Physical discription (if similar to another): Date of Birth: Or age:
Weight: Or size:

Feeding Instructions:

c Feed apart from other pets/supervisec Dispose of uneaten food c Remove food after _____minutes

c Dry Brand: c Morning Procedure:

Measure with: c Afternoon
Amount: c Dusk
Where to feed: c Night

c Wet Brand: c Morning Procedure:

Measure with: c Afternoon
Amount: c Dusk
Where to feed: c Night

c Medications c Morning Procedure:

Amount: c Afternoon
Location: c Dusk
Hide in treat: c Night

c Medications c Morning Procedure:

Amount: c Afternoon
Location: c Dusk
Hide in treat: c Night

c Water Fresh water will c Tap Dish location:

be provided at c Bottled
each visit c Filtered Water location:

c Treats Name: Notes:

Amount:
Location:
 Pg 1 of 3

Owner: Pet:

Pets Living Area

c Not allowed outdoors at any time c Allowed on furniture, counters, bed

c Only allowed outside on leash c Restrict pet area/crate when pet is alone
c Restrict pet area/crate at all times
c Let out, unsupervised, invisible fence yard with collar
c Let out, secure fence: Restricted area/crate location:

c Let out, unsupervised, no fence, but doesn't leave

Other
yard
off limit locations:

c Not allowed indoors

Emergency Care: Placing credit card on file at vets office is recommended

Vet Name: Pet allergies:

Clinic Name: Vaccinations up to date? (month/year):
Phone: Heartwarm test: Negative/Positive

Pet Medical History: (ongoing or reoccuring known illnesses/injuries, treatments, medication)

Temperament/Personality:
Pet doesn't like:
c Bath
c Strangers c Hot days c Sharing food dishes
c Massage c Rain/snow/cold c Loud noises/vacuum/thunder/garbage disposal
c Touch ears c New animals c All humans
c Sprays c Other family pets
c People near food dish
Pet reacts to the above by:

Has pet ever:

c Attacked someone/bit someone
c Attacked other animal Describe (even if under extreme/unusual situations)
c Injured self/escaped out of fear
c Injured self out of boredem
c Escaped from home
 Where does he/she like to escape to?
How can he/she be retrieved:
Pg 2 of 3

Owner:

Commands: Pet:

(Please circle commands we know and underline commands we are working on):

Sit No Outside Don't pull Potty Drop Bad_____ In the house

Stay Down Walk Walk nice Who’s here
Bath Good____ Ride
Allowed toCome
go for rides
Layin pet sitters
Food vehicle?
Make poo
Y/N Naughty Move Don't touch
__________
Heal Out Treat Cookie Back Off Come-on __________
Favorite games/activities, toys:

Comments:

Signature ___________________________________________________

Date ________________________