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Pet Information Form

Please fill in all details carefully so we can give your pet the best care

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Pet & Client Information

Client First Name

Client Last Name

Pet Name

Breed

Species

Canine Feline Avian (bird) Amphibian (Frog) Reptile (snake) Horse Goat Chicken Other

Approximate Date of Birth

Sex

Male Female

Color

Spayed or Neutered?

Yes No No – my pet is too young at the time of completion Not applicable due to the species of my pet

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Feeding Instructions

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

Location of where pet eats

Does your pet eat dry food?

Yes No Other

Dry food feeding times (check all that apply)

✓Not applicable ✓6:00am to 10:00am ✓12:00pm to 4:00pm ✓6:00pm to 9:00pm ✓8:00pm to 12:00am ✓Other

Name of dry food

Location where dry food is stored

Amount to feed per feeding

Item used to measure food

Does your pet eat wet food?

Yes No Other

Wet food feeding times (check all that apply)

✓Not applicable ✓6:00am – 10:00am ✓12:00pm – 4:00pm ✓6:00pm – 9:00pm ✓8:00pm – 12:00am ✓Other

Brand of wet food

Amount of wet food per feeding

Location where wet food is stored If not applicable, type N/A

Location of extra dry/wet food If not applicable, type N/A

Location where food dishes are stored when not in use If not applicable, type N/A

Location of extra food dishes If not applicable, type N/A

Does the pet have a routine before eating?

Yes No

Describe the routine in detail

Special eating requirements (check all that apply)

✓Not Applicable ✓Feed apart from other pets ✓Supervise while eating ✓Remove food after some time ✓Dispose of uneaten food

How much time before removing food?

Detailed feeding instructions

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Water

Type of water provided

Tap Filtered from fridge dispenser Filtered from pitcher in fridge Filtered from sink Bottled

Location of water dish Water dishes will be refilled at each visit and cleaned 1x per day.

Is your pet restricted to a certain amount of water?

Yes No

Amount of water to provide at each refill

Special instructions for water If not applicable, type N/A

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Treats & Medications

Does your pet receive treats?

Yes No

Treats per visit

1/2 to 1 treat 1–2 treats 3–4 treats No limit Other

When does your pet receive their treat?

Location where treats are stored If not applicable, type N/A

Special routine before getting a treat?

Treat requirements (check all that apply)

✓Give treats apart from other pets ✓Supervise while eating treat ✓Remove treat after some time ✓Dispose of uneaten treat ✓Not Applicable

Special instructions for treats

Does your pet receive medications? (No need to include monthly preventatives)

Yes No

Medication name

Location where medication is stored

Medication times

Directions

Additional information about medication If not applicable, type N/A

If your pet has more than one medication, list additional ones here

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Walking & Potty

Does your pet require a walk at our visits?

Please walk my pet at all visits At least 3 times per day, otherwise let my pet in the fenced yard At least 2 times per day, otherwise let my pet in the fenced yard At least 1 time per day, otherwise let my pet in the fenced yard Please only let my pet into the fenced yard. No walks required. My pet is NOT allowed outside. They use a litter box or potty pad. My pet is an outdoor pet. No walks are necessary.

Location of pet's leash and/or collar

Areas to avoid while walking

Pet's walking route

Location of pet waste bags

Where should we dispose of all pet waste?

Does your cat use a litter box or dog use potty pads?

Yes No

Location of litter box or potty pad

Location of extra litter or potty pads

How often do you scoop/change soiled pads?

Not Applicable Once every other day Once per day Twice per day Three times per day Four times per day Everytime the pad is soiled

Is this paperwork for a bird or small caged pet?

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Play, Behavior & Living

Games and activities your pet enjoys (check all that apply)

✓Belly Rubs ✓Cuddle ✓Give kisses ✓Fetch ✓Tug-o-war ✓Chase ✓Walk ✓Run/Jog ✓Play with toys ✓My pet does NOT play ✓Other

Does your pet play with toys?

Yes No

Location of toys

Favorite toys

Is your pet crated or placed in a restricted area when no one is home?

Yes No

Pet's living situation (check all that apply)

✓NOT allowed outdoors at all ✓Kept Outside in fenced yard ALL DAY ✓Kept Outside in fenced ALL DAY & NIGHT ✓NOT allowed indoors at all ✓Allowed on furniture & beds ✓Allowed on counters & tables ✓Restrict pet area/crate ALL DAY & ALL NIGHT ✓Restrict pet area/crate NIGHT ONLY ✓My pet is not restricted and can access the entire house ✓Other

Location of crate, gated area, or fenced yard Type N/A if not applicable

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Health & Safety

Things your pet does NOT like (check all that apply)

✓Baths ✓Hot Days ✓Sharing Food Dishes ✓People near food dish ✓People near treats ✓Nail trims ✓Rain ✓Cold ✓Loud Noise ✓Vacuum ✓Thunder ✓Petting Hind End ✓Petting near the head ✓New or Strange Animals ✓Humans ✓Touching Ears ✓Strangers ✓Fragrance Sprays ✓Touching Feet ✓Other family pets ✓None of the above ✓Other

How does your pet react to the above? If not applicable, type N/A

Has your pet ever done any of the following? (check all that apply)

✓Attacked and/or bit someone ✓Attacked and/or bit another animal ✓Escaped from home ✓Injured self out of boredom/fear ✓Not Applicable

Describe any incidents (even mild or unusual circumstances) If not applicable, type N/A

Where does your pet like to escape or hide?

✓Hides behind or under bed ✓Hides behind or under couch ✓Hides under tables ✓Hides in closets ✓Runs out doors ✓Runs upstairs ✓Not Applicable ✓Other

How can your pet be retrieved? If not applicable, type N/A

Does your pet have any ongoing illnesses, injuries, or medical treatments?

Yes No

If yes, explain in detail

Did your pet have a previous illness or injury we should know about?

Yes No Unknown

If yes, explain in detail

Has your pet been diagnosed with allergies?

Yes No

Type of allergies

Symptoms when allergies flare up

Temperament and personality (check all that apply)

✓Calm ✓Sweet ✓Loving ✓Cuddly ✓Aggressive ✓Hyper ✓Shy ✓Scared ✓Timid ✓Relaxed ✓Easy Going ✓Pushy ✓Suspicious ✓Aloof ✓Fearful ✓Lazy ✓Jealous ✓Trusting ✓Spiteful ✓Crazy ✓Other

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Signature & Submission

Form prepared by – First Name

Last Name

Date

Signature

Please use your mouse or finger to sign below.

Pet Information Form

Pet & Client Information

Feeding Instructions

Water

Treats & Medications

Walking & Potty

Play, Behavior & Living

Health & Safety

Signature & Submission

Services

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+91 9084668321

vet@zootoopia.in

Shop No. 8, Ground FloorComplex Street-76, Sector – 76, NoidaNear Slicon City Gate No. – 4 (UP-201301)

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