New Client/Pet Questionnaire

Please complete this form AFTER speaking to PCBA Vet Tech Sitters, LLC.

First Name

Home Address

Zip Code

Complex Name

Email Address

Alarm/Garage Code

Pet Name(1) :

Age(1) :

Birthdate(1) :

Breed(1) :

Gender (1)

Last Name

Town

Cell Phone:

Emergency Contact Name

Emergency Contact Number

Wifi Login/Password

Pet Name(2) :

Age(2) :

Birthdate(2) :

Breed(2) :

Gender(2) :

Is your pet spayed or neutered?

Any history of biting? (1)

YES

Any history of biting? (2)

YES

What kind of food does your pet(s) eat?

Where is the food located?

What time(s) of day does your pet eat and how much?

Any special feeding instuctions please list below!

Is your pet(s) currently on any medication? If yes, please list medication name,dosage,and how it is administered. Please be specific!

Does your pet(s) have any special hiding spots?

Does your pet(s) enjoy other animals?

Does your pet(s) enjoy other people?

Where is the liter box located?

Where is the leash located?

Can your pet(s) have treats? If yes, where are they located and what kind are they?

Where are your cleaning supplies located?

Preferred place to dispose of trash?

Where will the key be located for us for our first visit? Where would you like us to leave the key after our final visit?

What is the name of your primary veterinary hospital?

If there is any medical emergency do you give PCBA vet tech sitters, LLC permission to bring your animal(s) to your primary veterinarian or if after hours to the nearest emergency veterinary hospital? *Owner will be responsible to pay for all services deemed necessary by a licensed veterinarian*

Does PCBA vet tech sitters LLC have permission to post your pets photo on our social media accounts? Please list any handles you would like tagged as well! *We will not use last names in post*

How did you hear about us?

Today's Date

Your Signature

Thanks for submitting!