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PROFESSIONAL PET CARE SERVING THE UPPER VALLEY

Pet Sitting Services
Client Intake Paperwork
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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

Household + Emergency Information

This form covers basic household information, emergency contacts, and more.

Primary Pet Owner's Name: *

First

Last

Cell Phone #: *

Secondary Pet Owner's Name:

First

Last

Cell Phone #:

Others living in home:

Physical Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different):

Address Line 1

Address Line 2

City

State

Zip Code

Brief Directions:

Home Phone:

Office Phone:

Email: *

Preferred Method of Contact:

Call
Text
Email

EMERGENCY MAINTENANCE

Please list your emergency maintance providers for fuel, heat, electricity, etc.

Fuel Supplier:

Phone:

Furnace Repair:

Phone:

Plumber:

Phone:

Electrician:

Phone:

General Maintenance:

Phone:

Where will the key be kept? *

Will a duplicate key be given to the pet caregiver? *

Is there an access code #? *

Please provide code number if applicable

Preferred door of entry: *

Please list location of these item:

Leashes: *

Pet food:

Pet meds:

Pet carrier:

Pet treats:

Litter box:

Broom/vacuum:

Cleaning items:

Trash can:

Fire extinguishers:

Water shut off:

Electricity Panel:

Pet towels:

Pet brushes:

Other?

General Instructions

Specific pet care instructions will be covered on pet intake forms

Most of these are complimentary but some of these services my incur a small fee depending on the time involved. This can be negotiated with the caregiver assigned to your household.

Bring in the mail and packages?

Yes
No

Bring the newspaper?

Yes
No

Water indoor plants?

Yes
No

Water outdoor plants?

Yes
No

Fill outside feeders?

Yes
No

Other chores:

Special Instructions

Are there areas of the home, outbuildings, or yard that you prefer the pet sitter not enter? (except in the case of an emergency)

Any other quirks or restrictions the caregivers should be aware of? (sticky doors, doors that may not latch, shake the handle of the toilet, leaky basement when it rains?)

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

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