Pet Info Form Your InformationYour Name First Last Your Phone Your Email Preferred Method of ContactEmailPhoneBest Time to Contact You Your Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code House Access and Related ItemsSuch as where to get and leave key/alarms/garage door and WiFi/internet name and password if appropriate.Typical Household SchedulesGarbage pickup, mail/package delivery, or yard services (pet okay with them)? Anything you are expecting for delivery or pickup during service period?Other Household ParticularsSuch as thermostat, location of paper towels, toilet paper, garbage bags, etc.Helpful Videos and PicturesTo ensure the highest level of quality and care, please provide any informational pictures or videos. This can be for handling pets or your preferences for performing certain functions in the house. Drop files here or Select files Accepted file types: jpg, gif, png, pdf, mov, jpg4, Max. file size: 100 MB. Vet & Emergency Contact InformationVet HospitalMountain Hospital for AnimalsOtherIf Other, please enter hospital here: Specific DoctorDr. KellerDr. WhitfordDr. Keller and/or Dr. WhitfordOtherIf Other, please enter doctors names here: Credit Card on File with Vet Yes No Vet Phone Vet Email Vet Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code First Emergency Contact First Last First Emergency Contact Phone First Emergency Contact Email Where did you hear about me?Lkt Mtn FacebookFriend or acquaintanceOtherPlease provide the name of the person who referred you. Please let me know where you heard about me. Pet 1 InformationPet 1 Name First Pet TypeDogCatPet Breed Pet 1 Age (best guess)Pet 1 Weight (best guess)If Have Pet Insurance – Name Microchipped Yes No Pet 1 Any AllergiesPlease be specific and what precautions and medication must be taken. Select Feeding Schedule for Pet 1 Breakfast Lunch Dinner Available All Day Other Feeding Notes(amount/mixture, time of feedings and any special instructions)Medication(s) & InstructionsSuch as for heart worm, prescriptions, upset tummy, or anxiety.Sleep Schedule (any special instructions)(typical wake and bedtime times and routines)Potty Schedule (any special instructions)(first and last potty routine info)Behavior NotesMost importantly, any “not so good” behavior tendencies as well as how best to handle them. Please also include things such as likes/dislikes/quirks such as liking/not liking other animals, loves belly rubs, hates for feet/ears to be touched, favorite toys, how they react to storms, etc.Any Other Notes or InformationPermission to post photos of pet on my FaceBook page and this Site?I know how important privacy is. I would only post a photo of your pet with no identifying information. With that said, I’m more than happy to ensure your privacy if you answer “No” here. YesNoA Second Pet? Yes No Pet 2 InformationPet 2 Name First Pet 2 TypeDogCatPet 2 Breed Pet 2 Age (best guess)Pet 2 Weight lbs. (best guess)Is Pet 2 Insurance different than Pet 1? Yes No Pet 2 Insurance – Name Pet 2 Microchipped Yes No Pet 2 Any AllergiesPlease be specific and what precautions and medication must be taken. Is feeding schedule different from Pet 1? Yes No Select Feeding Schedule for Pet 2 Breakfast Lunch Dinner Available All Day Other Pet 2 Feeding Notes(amount/mixture, time of feedings and any special instructions)Pet 2 Medication(s) & InstructionsSuch as for heart worm, prescriptions, upset tummy, or anxiety.Is Sleep Schedule different from Pet 1? Yes No Pet 2 Sleep Schedule (any special instructions)Is Potty Schedule different from Pet 1? Yes No Pet 2 Potty Schedule (any special instructions)Pet 2 Behavior NotesMost importantly, any “not so good” behavior tendencies as well as how best to handle them. Please also include things such as likes/dislikes/quirks such as liking/not liking other animals, loves belly rubs, hates for feet/ears to be touched, favorite toys, how they react to storms, etc.Any Other Notes or Information For Pet 2A Third Pet? Yes No Pet 3 InformationPet 3 Name First Pet 3 TypeDogCatPet 3 Breed Pet 3 Age (best guess)Pet 3 Weight lbs. (best guess)Is Pet 3 Insurance different than Pet 1? Yes No If have Pet 3 has Insurance – Name Pet 3 Microchipped Yes No Pet 3 Any AllergiesPlease be specific and what precautions and medication must be taken. Is feeding schedule for Pet 3 different from Pet 1? Yes No Select Feeding Schedule for Pet 3 Breakfast Lunch Dinner Available All Day Other Pet 3 Feeding Notes – if necessary(amount/mixture, time of feedings and any special instructions)Pet 3 Medication(s) & InstructionsSuch as for heart worm, prescriptions, upset tummy, or anxiety.Is Sleep Schedule for Pet 3 different from Pet 1? Yes No Pet 3 Sleep Schedule (any special instructions)Is Potty Schedule for Pet 3 different from Pet 1? Yes No Pet 3 Potty Schedule (any special instructions)Pet 3 Behavior NotesMost importantly, any “not so good” behavior tendencies as well as how best to handle them. Please also include things such as likes/dislikes/quirks such as liking/not liking other animals, loves belly rubs, hates for feet/ears to be touched, favorite toys, how they react to storms, etc.Any Other Notes or Information For Pet 3A Fourth Pet? Yes No Pet 4 InformationPet 4 Name First Pet 4 TypeDogCatPet 4 Breed Pet 4 Age (best guess)Pet 4 Weight lbs. (best guess)Is Pet 4 Insurance different than Pet 1? Yes No Pet 4 Insurance – Name Pet 4 Microchipped Yes No Pet 4 Any AlergiesPlease be specific and what precautions and medication must be taken. Is feeding schedule for Pet 4 different from Pet 1? Yes No Select Feeding Schedule for Pet 4 Breakfast Lunch Dinner Available All Day Other Pet 4 Feeding Notes – if necessary(amount/mixture, time of feedings and any special instructions)Pet 4 Medication(s) & InstructionsSuch as for heart worm, prescriptions, upset tummy, or anxiety.Is Sleep Schedule for Pet 4 different from Pet 1? Yes No Pet 4 Sleep Schedule (any special instructions)Is Potty Schedule for Pet 4 different from Pet 1? Yes No Pet 4 Potty Schedule (any special instructions)Pet 4 Behavior NotesMost importantly, any “not so good” behavior tendencies as well as how best to handle them. Please also include things such as likes/dislikes/quirks such as liking/not liking other animals, loves belly rubs, hates for feet/ears to be touched, favorite toys, how they react to storms, etc.Any Other Notes or Information For Pet 4A Fifth Pet? Yes No Pet 5 InformationPet 5 Name First Pet 5 TypeDogCatPet 5 Breed Pet 5 Age (best guess)Pet 5 Weight lbs. (best guess)Is Pet 5 Insurance different than Pet 1? Yes No Pet 5 Insurance – Name Pet 5 Microchipped Yes No Pet 5 Any AllergiesPlease be specific and what precautions and medication must be taken. Is feeding schedule for Pet 5 different from Pet 1? Yes No Select Feeding Schedule for Pet 5 Breakfast Lunch Dinner Available All Day Other Pet 5 Feeding Notes – if necessary(amount/mixture, time of feedings and any special instructions)Pet 5 Medication(s) & InstructionsSuch as for heart worm, prescriptions, upset tummy, or anxiety.Is Sleep Schedule for Pet 5 different from Pet 1? Yes No Pet 5 Sleep Schedule (any special instructions)Is Potty Schedule for Pet 5 different from Pet 1? Yes No Pet 5 Potty Schedule (any special instructions)Pet 5 Behavior NotesMost importantly, any “not so good” behavior tendencies as well as how best to handle them. Please also include things such as likes/dislikes/quirks such as liking/not liking other animals, loves belly rubs, hates for feet/ears to be touched, favorite toys, how they react to storms, etc.Any Other Notes or Information For Pet 5A Sixth Pet? Yes No Pet 6 InformationPet 6 Name First Pet 6 TypeDogCatPet 6 Breed Pet 6 Age (best guess)Pet 6 Weight lbs. (best guess)Is Pet 6 Insurance different than Pet 1? Yes No Pet 6 Insurance – Name Pet 6 Microchipped Yes No Pet 6 Any AllergiesPlease be specific and what precautions and medication must be taken. Is feeding schedule for Pet 6 different from Pet 1? Yes No Select Feeding Schedule for Pet 6 Breakfast Lunch Dinner Available All Day Other Pet 6 Feeding Notes – if necessary(amount/mixture, time of feedings and any special instructions)Pet 6 Medication(s) & InstructionsSuch as for heart worm, prescriptions, upset tummy, or anxiety.Is Sleep Schedule for Pet 6 different from Pet 1? Yes No Pet 6 Sleep Schedule (any special instructions)Is Potty Schedule for Pet 6 different from Pet 1? Yes No Pet 6 Potty Schedule (any special instructions)Pet 6 Behavior NotesMost importantly, any “not so good” behavior tendencies as well as how best to handle them. Please also include things such as likes/dislikes/quirks such as liking/not liking other animals, loves belly rubs, hates for feet/ears to be touched, favorite toys, how they react to storms, etc.Any Other Notes or Information For Pet 6EmailThis field is for validation purposes and should be left unchanged. Δ
