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PROFESSIONAL PET CARE SERVING THE UPPER VALLEY

Pet Sitting Services
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Pet First Aid & Wellness

Contact Us

Email:
uvpc@uppervalleypetcare.com

Telephone:
603-291-3043

Phone Hours:
Monday-Friday: 8:00am-6:00pm
Saturday: 10am-4pm
Closed Sunday

Canine Information Form

This is our Canine Information Form, please fill out ONE FORM PER EACH PET. Please answer ALL questions and information completely.

Name of Dog: *

Name of Primary Pet Owner: *

First

Last

Cell Phone #: *

Email: *

Preferred method of contact:

Call
Text
Email

Name of Secondary Pet Owner:

First

Last

Cell Phone #:

Email:

Preferred method of contact

Call
Text
Email

Breed: *

Colors/Markings: *

Date of Birth: *

Sex *

Male
Female

Is your dog spayed/neutered? *

Yes
No

Weight: *

How long have you had this dog? *

Did you get this dog as a: *

Is this dog microchipped: *

Health Information

General Health Information: *

Any history of, or current illness or disabilities with this dog? *

Are there any physical lumps, warts, skin tags, abnormalities, or other noteworthy things the pet sitter should be aware of? *

Is your dog current with vaccinations? *

Yes
No

Rabies Tag #: *

Expiration Date: *

Veterinarian's Name: *

Veterinarian's Phone Number: *

List any medications/supplements including Name of meds, Dosage, What time it is given and How it is administered: *

Behavioral Information

How would you rate your dogs general behavior? *

Excellent
Very Good
Good
Average
Poor
Challenging

In a few words, please describe your dog's personality: *

How would you rate your dog's energy level? *

Low energy
Average
High energy
Hyperactive

Does your dog respond to basic commands? *

How is your dog's recall? *

Does your dog jump on people? *

Yes
No
Used to, but not currently

Has your dog ever bitten, scratched, or harmed another person? *

Yes
No

If yes, please explain:

Does your dog get along with new people? *

Does your dog get along with other dogs? *

Does your dog get along with other cats? *

Has your dog ever or currently had any aggressive behaviors? (Examples: food/resource guarding, protective in car/house? *

Is your dog afraid of anything? (Examples: thunder, vacuum cleaner, separation anxiety) *

What motivates your dog? (petting, play, ball, food) *

What is your dog's favorite activity? (ball, swimming, tummy rubs) *

DOES YOUR DOG?

Please answer each question below

Chatter teeth or chomp when excited or angry? *

Nip when playing? *

Ever go hunting for sport? (if yes, what game?) *

Chase deer? *

Chase cars? *

Like to ride in the car? *

Like to play in the water? *

Like to chase balls? *

Like children? *

Prefer men or women? *

Like to be groomed? *

Like being petted? *

Like being massaged? *

Ever run away? *

Ever have accidents in the house? *

Get into the trash? *

CAN YOUR DOG?

Please answer each question below

Be put in a crate if needed? *

Be left in a vehicle for a short period? *

Be picked up? *

HAS YOUR DOG?

Please answer each question below

Ever been crated? *

Been trained on an e-collar? *

Attended a formal training class? *

Ever been allowed off-leash? *

Ever had submissive urination or nervous bowels? *

Feeding & Care Instructions

Please answer each question below

Brand of dog food: *

Amount fed: *

How often?: *

Usual feeding time?: *

Any medications/supplements?: *

Treats?: *

Food Allergies?: *

Special Instructions:

Should your dog be walked on leash? *

On property only? *

Off property? *

Is there a fenced in yard for your dog? *

Is there an underground or wireless fence? *

Any areas of the house or yard that is off limits to your dog? *

Is your dog to be crated or confined when the caregivers leaves? *

Where does your dog typically sleep at night? *

Any other information for your pet sitter or dog walker?

Client Signature

I acknowledge that all of the information is complete, accurate and up to date to the best of my knowledge. I acknowledge that I have read and will adhere to the policies and procedures.

Electronically Sign Here: *

Please type your full name

Date / Time: *

Date

Time

Email