Pet Sitter Form

What your pet sitter, veterinarian and emergency facility need to know when you leave town!

We want you to enjoy your time away from home. To help you, we encourage you to make preparations with your pet sitter before you leave should your pet(s) become ill or injured. With this in mind, please take a moment to fill out this emergency contact and pet information form and leave it with your pet sitter. Some of the questions may be difficult for you to answer, but they would be even more difficult for your pet sitter to answer without your guidance.

Be sure your pet has adequate ID, and provide your pet sitter with a recent photo and description of your pet in case your pet becomes lost.

PET SITTING DATES

Start Date*:

End Date*:

While you are away, where can we contact you?

Your Name (required)

Your Email (required)

Where will you be? (required)

Your Phone Number (required)

Who is your daytime veterinarian?

Vet Name (required)

Vet Phone Number (required)

Pet Sitter Information

Pet Sitter Name (required)

Pet Sitter Phone Number (required)

Pet Information

Pet's Name (required)

Pet Type (required)

Pet Age (required)

Pet Color (required)

Male / Female: MaleFemale

Spayed or Neutered:  Yes No

Pet History

Dates of Last Vaccinations

Rabies:

Distemper (Dogs):

Parvo:

Leukemia (Cats):

Upper Resp/Distemper:

Other:

Date of last Heartworm test:

Date of last Fecal Exam:

Is your cat FELV positive? NoYes

Is your cat FIV positive? NoYes

Does your pet have any known medical problems? If so, please describe:

Is your pet on any medication? Please give drug name, dosage, and how often it is administered:

Is your pet allergic to any medications? If so, please give the name of the drug(s):

Please READ each of the following and INDICATE YOUR CHOICE in the event your pet suffers from illness or injury.(REQUIRED)

1. In the event that I am unavailable elect complete medical care for my pet
2. In the event that I am unavailable; I elect minimal treatment for my pet to prevent life threatening concerns. Minimal treatment can include the need for intravenous fluids, oxygen, blood, plasma, and possible intensive care treatments
3. I decline treatment for my pet without my permission. I understand that if I am unavailable and my pet's life is threatened, no treatment shall be done and I waive all responsibility of the pet sitter and the veterinary hospital.

Please select your choice for medical treatment of your pet-REQUIRED
1. Complete Medical Care2. Minimal Medical Care3. Decline Medical Treatment without permission

After examination, an estimate will be given for diagnostics and medical care. Your pet sitter will be required to sign the estimate and YOU will be financially responsible. WE REQUIRE A DEPOSIT OF THE MINIMUM END OF THE ESTIMATE BEFORE SERVICES ARE RENDERED. Please discuss limitations in advance with your pet sitter. You may also sign a form when you visit our office giving authorization to place medical expenses on a major credit card.

By typing your name in the below signature box you are verifying that all the information provided is true to the best of your knowledge and you are assuming responsibility for all medical expenses for your pet while under the care of Animal Health Services.

Signature (required)YOU MUST SELECT A MEDICAL TREATMENT OPTION ABOVE OR THIS FORM WILL BE CONSIDERED VOID

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