Your Pet's Nanny Client Information Form

Your Pet's Nanny - Client Info Form
Please fill out this form so we may better serve you. This may take a few minutes of your time.

Client Information
Your Name*

First NameLast Name
Spouse's / Partner's Name: (Optional)

First NameLast Name
Primary E-mail:*

Confirmation Email
Secondary E-mail: Optional

Confirmation Email
Home Address:*

Street Address

Apartment or Unit #:

CityState

Zip Code
Is your mailing address different than your home address?*

NoYes
Mailing Address:

Street Address

Street Address Line 2

CityState

Zip Code
Is your home alarmed?*

NoYes
Please describe how to disarm and rearm your alarm system:
**I recommend creating a special alarm code just for me (for your security we can discuss this over the phone). This way you can turn it on when you're away, and turn it off when you're back and it allows you to keep your personal code private.**
Mobile Phone 1:*
Do we have your permission to send text messages to this #?*

YesNo
Home Phone #: (Optional)
Do you have an alternate # if you can't be reached on your primary phone? (Optional)
Do we have your permission to send text messages to this #?

YesNo

Pet Information

You can list up to 4 pets on this form
Total # of pets to be cared for*
What type of animal(s) will we be caring for? Check all that apply:*

CatDogBirdBunny / RabbitFish Tank / PondPocket Pet (Hamsters, Rats, Mice etc.)ReptilesOther
Pet #1: Name*
Pet #1: Age: (Approximate)*
Pet #1: Type of animal
Pet #1: Has your dog ever bitten anyone and/or another dog or other animal?
Pet #1: Briefly describe the circumstance where your dog bit someone and/or another dog or other animal
Pet #1: Does your dog show signs of aggression to people and/or other dogs/animals?
Pet #1: Briefly describe your dog's signs of aggression
Pet #1: Does your dog jump on people, pull on the leash, or show other signs of dominance?
Pet #1: Briefly describe your dog's signs of domnance
Pet #1: Sex*
Pet #1: Spayed / Neutered:*
Pet #1: Weight: (Approximate)*
Pet #1: Breed
Pet #1: Color and Description - Please describe your pet*
Pet #1: Is pet microchipped?*
Pet #1: Microchip ID #:
Pet #1: Microchip Company's Name:
Pet #1: Microchip Company's Phone #:
Pet #1: Does your pet have a city license?*
Pet #1: City and License #
Pet #1: Are your pet's vaccinations are up to date?*
Pet #1: Does your pet have any behavioral concerns?*
Pet #1: Describe any behavioral concerns
Pet #1: Does your pet have any health concerns?*
Pet #1: Describe any health concerns below
Does Pet #1 take any medications or supplements?*
Pet #1: List the doesages of medications and/or supplements below
Pet #1 Feeding Instructions
Pet #1: Name of pet food*
Pet #1: Where do you keep the food?*
Pet #1: Amount to serve per feeding:*
Pet #1: Number of feedings per day:*
Can Pet #1 have treats?*
Pet #1: Does your pet have any food allergies?*
Pet #1: Describe your pet's food allergies:
Pet #1: List any additional feeding instructions
Click on the triangle to expand the form to list another pet

Pet #2
Pet #2: Name
Pet #2: Type of animal
Pet #2: Has your dog ever bitten anyone and/or another dog or other animal?
Pet #2: Briefly describe the circumstance where your dog bit someone and/or another dog or other animal
Pet #2: Does your dog show signs of aggression to people and/or other dogs/animals?
Pet #2: Briefly describe your dog's signs of aggression
Pet #2: Does your dog jump on people, pull on the leash, or show other signs of dominance?
Pet #2: Briefly describe your dog's signs of domnance
Pet #2: Age: (Approximate)
Pet #2: Sex
Pet #2: Spayed / Neutered
Pet #2: Weight (Approximate)
Pet #2: Breed
Pet #2: Color and Description - Please describe your pet
Pet #2: Is pet microchipped?
Pet #2: Microchip ID #
Pet #2: Microchip Company's Name
Pet #2: Microchip Company's Phone #
Pet #2: Does your pet have a city license?
Pet #2: City and License #
Pet #2: Does your pet have any behavioral concerns?
Pet #2: Describe any behavioral concerns
Pet #2: Does your pet have any health concerns?
Pet #2: Describe your pet's health concerns:
Pet #2: Does your pet take any medications and/or supplements?
Pet #2: List the doesages of medications and/or supplements below
Pet #2 Feeding Instructions
Pet #2: Name of pet food
Pet #2: Where do you keep the food?
Pet #2: Amount to serve per feeding:
Pet #2: Number of feedings per day:
Can Pet #2 have treats?
Does Pet #2 have any food allergies?
Describe Pet #2 food allergies:
List any additional feeding instructions for Pet #2:

Pet #3
Pet #3: Name
Pet #3: Type of animal
Pet #3: Has your dog ever bitten anyone and/or another dog?
Pet #3: Please describe the circumstance where your dog bit someone and/or another dog
Pet #3: Does your dog show signs of aggression to people and/or other dogs/animals?
Pet #3: Briefly describe your dog's signs of aggression
Pet #3: Does your dog jump on people, pull on the leash, or show other signs of dominance?
Pet #3: Briefly describe your dog's signs of domnance
Pet #3: Age (Approximate)
Pet #3: Sex
Pet #3: Spayed / Neutered
Pet #3: Weight (Approximate)
Pet #3: Breed
Pet #3: Color and Description - Please describe your pet
Pet #3: Is pet microchipped?
Pet #3: Microchip ID #
Pet #3: Microchip Company's Name
Pet #3: Microchip Company's Phone #
Pet #3: Does your pet have a city license?
Pet #3: City and License #
Pet #3: Are your pet's vaccinations are up to date?
Pet #3: Does your pet have any behavioral concerns?
Pet #3: Describe any behavioral concerns
Pet #3: Does your pet have any health concerns?
Pet #3: Describe your pet's health concerns:
Pet #3: Does your pet take any medications and/or supplements?
Pet #3: List the doesages of medications and/or supplements below
Pet #3 Feeding Instructions
Pet #3: Name of pet food
Pet #3: Where do you keep the food?
Pet #3: Amount to serve per feeding
Pet #3: Number of feedings per day
Can Pet #3 have treats?
Pet #3: Does your pet have any food allergies?
Pet #3: Describe your pet's food allergies
Pet #3: List any additional feeding instructions

Pet #4
Pet #4: Name
Pet #4: Type of animal
Pet #4: Has your dog ever bitten anyone and/or another dog?
Pet #4: Please describe the circumstance where your dog bit someone and/or another dog
Pet #4: Does your dog show signs of aggression to people and/or other dogs/animals?
Pet #4: Briefly describe your dog's signs of aggression
Pet #4: Does your dog jump on people, pull on the leash, or show other signs of dominance?
Pet #4: Briefly describe your dog's signs of domnance
Pet #4: Age (Approximate)
Pet #4: Sex
Pet #4: Spayed / Neutered
Pet #4: Weight (Approximate)
Pet #4: Breed
Pet #4: Color and Description - Please describe your pet
Pet #4: Is pet microchipped?
Pet #4: Microchip ID #
Pet #4: Microchip Company's Name
Pet #4: Microchip Company's Phone #
Pet #4: Does your pet have a city license?
Pet #4: City and License #
Pet #4: Are your pet's vaccinations are up to date?
Pet #4: Does your pet have any behavioral concerns?
Pet #4: Describe any behavioral concerns
Pet #4: Does your pet have any health concerns?
Pet #4: Describe your pet's health concerns:
Pet #4: Does your pet take any medications and/or supplements?
Pet #4: List the doesages of medications and/or supplements below
Pet #4 Feeding Instructions
Pet #4: Name of pet food
Pet #4: Where do you keep the food?
Pet #4: Amount to serve per feeding
Pet #4: Number of feedings per day
Can Pet #4 have treats?
Pet #4: Does your pet have any food allergies?
Pet #4: Describe your pet's food allergies
Pet #4: List any additional feeding instructions
Check this box if you have more than 4 pets

I have more than 4 pets
If you have more than 4 pets use the box below to list their names and general info.

Veterinary Info

You are encouraged to contact your vet's office and let them know you'll be away and ask them what their policies are if your pet sitter needs to bring your pets in for medical care while you're away. If your vet's office is unavailable you will need to make alternative arrangements. VMSG (Veterinary Medical Surgical Group) is the only 24 hour emergency pet hospital in Ventura. You are encouraged to contact them and fill out their forms also.
Veterinarian or Veterinary Clinic:*
Preferred Veterinarian (Optional)

First NameLast Name
Veterinary Office Address*

Street Address

Street Address Line 2

CityState

Zip Code
Veterinarian Phone #:*
I have contacted my vet's office and filled out their forms for medical care*
I have have made alternative arrangements for medical care if my vet is not available*
List Emergency Veterinarian or Vet Clinic

Emergency / Alternative Vet

Street Address

CityState

Zip Code
I would like to download, print, and fill out a Pet Care Emergency Authorization Form (provided by https://www.aaha.org/protected_documents/pet_owner/petcareemgauthform.pdf)*
By checking this box is the same as your signature: I understand that veterinary services are a separate contract between me, the pet owner and vet's office and that I am responsible for any medical expenses incurred while caring for my animal(s), and I will reimburse you for expenses you may have incurred getting my pet(s) to the vet while under your care.

Misc. Services & Info
Check any other services you might like done while you're away:

Bring in the mailBring in the newspaperAdjust lightingAdjust window treatmentsWater plantsOther
Please include the Mailbox # (if applicable) and general directions to it:
Mailbox JJ #1 on the corner of Main and 1st Streets
Use the space below to list the plants that need to be watered:
Indoor and outside plants, ok!
Is there a handyman or management company you want us to call in case of a household problem or emergency?*

YesNo
Handyman / Management Company Name:
Handyman / Management Company Phone Number:
List any additional information I need to know to better serve you and your pets:
Read this before you submit this form

After you click Submit Form remain on this page to let the form load. This may take a few seconds. Do not click away until you are redirected to a "Thank you" page. You will receive a copy of this form if you spelled your email correctly. SAVE THAT EMAIL. Once services are confirmed we'll send confirmation and invoicing separately. Don't see it in your inbox? Check your junk folder or allow emails from info@yourpetsnanny.com.
Enter the message as it's shown*
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Your Pet's Nanny - Client Info Form