Pet Information Disclosure, please print or ask for a copy before my initial visit. 
Please complete one pet information disclosure per pet, aquarium, or litter.
Pet Name:_____________________________________   Owners Name:___________________________   phone #___________ cell_____________
emergency name and #_________________________
Length of time owned: _________________________     Pet Type:Dog / Cat / Horse /Other____________   
Breed:________________________________________  Declawed:  Y/N     Neutered:  Y/ N      Sex:  M/F  
Physical Description (if similar to another):      Birth date or age: ______________________         

Feeding Instructions:   
Treats   _________________ 
Amt: ____________
Location: ____________
Northshore Pet Sitters 
Copyright  © 2003        
 Name: _____________________ 
Veterinary and Medical: 
Pet Medical History: (ongoing or reoccurring known illnesses/injuries, treatments & medications): 
Emergency Care (placing a credit card on file at your veterinary office is recommended):
Vet Name:_____________________________________ Pet Allergies: ________________________________
Clinic Name: ____________________________________
Vaccinations up to date on (month/yr): ____________
Phone: ____________________________________________
Heartworm test:  Negative / Positive 

Pet Doesn’t Like: 
Baths   Hot Days   Sharing Food Dishes  
Toenail Clip   Rain / Snow / Cold   Loud Noise / Vacuum / Garbage Disposal / Thunder  
Massage   New Animals   All Humans 
Touch Ears   Other family pets     Strangers 
 Sprays   People near food dish   Other:____________________________________
If checked, please describe 
Has Pet Ever: Describe (even if mild, or under extreme/unusual situations) 
Attacked someone/bit someone   
Attacked another animal 
Injured self /escaped out of fear 
Injured self out of boredom 
Escaped from home    If so, where does he/she like to escape to? How can he/she be retrieved? 
Commands:  (list commands your pet knows): 
Allowed to go for rides in sitter vehicle if emergency?  Y / N        
Favorite Games, Toys, and Activities:  
Signature: _____________________________________________  
Date: ______________________
Northshore Pet Sitters 
Copyright  © 2003