Client Profile Worksheet

Date of Initial Contact_____________________________________________________________________________________

Name _________________________________________________________________________________________________

Address ________________________________________________________________________________________________

City/State/Zip __________________________________________________________________________________________

Directions _____________________________________________________________________________________________

______________________________________________________________________________________________________

Contact Information

Home ________________________________________________________________________________________________

Work _________________________________________________________________________________________________

Work 2 ________________________________________________________________________________________________

Cell 1 _________________________________________________________________________________________________

Cell 2 _________________________________________________________________________________________________

Fax number ____________________________________________________________________________________________

Email Address ___________________________________________________________________________________________

Local Contact __________________________________________________________________________________________

Contact info for current trip _______________________________________________________________________________

______________________________________________________________________________________________________

Most Common Reason for Service

_____Business travel                              _____Vacation                 ______weekday lunch visit        _____emergency visit

Pets	Type	Size	Age
1
2
3
4

Do any pets require special medical needs? ________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

Do any pets require special handling? ______________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

Extra Information

Pet Profile Worksheet

Pet Name _____________________________________________________________________

Owner Name/address _______________________________________________________________________________

Type of animal _____________________________________________________________________________________

Feeding

What brand and type of food does the pet eat? ___________________________________________________________

Where is the pet food typically purchased? ______________________________________________________________

Feeding Instructions

_____ Dry Food and canned food mixed together          _____Dry food and canned food fed in separate dishes

_____ Water in dry food                                             ______ Pet tends to eat food immediately and completely

_____ Pet is a fussy eater                                         _____ Pet tends to eat food over course of time

Does the pet get treats regularly? _________________________________________________________________________

Does the pet have any dietary constraints? _________________________________________________________________

Medications

Does the pet receive any medication? _____________________________________________________________________

What is the medication? ________________________________________________________________________________

What is it for? _________________________________________________________________________________________

Where is the medication kept? ___________________________________________________________________________

How frequently is it administered? _________________________________________________________________________

How is it administered? __________________________________________________________________________________

What is the source of the medication? ______________________________________________________________________

(veterinary or regular drugstore)

Behavior

Does your pet have any behavioral idiosyncrasies? __________________________________________________________

Does the pet get along with other pets in the household? ______________________________________________________

Should the pet be separated from another pet when left alone? _________________________________________________

Is the pet well socialized with other pets of its species? _______________________________________________________

Exercise

What kind of regular exercise should the pet receive during the pet sitting period? __________________________________

______________________________________________________________________________________________________

Attach Photo Here (update annually if pet is a juvenile)

"HOLD HARMLESS" AGREEMENT & LIABILITY RELEASE FOR SASSY’S PLACE

RESPONSIBILITY & LIABILITY:

I feel confident that SASSY’S PLACE makes every effort to provide a clean, safe, open environment for all pets that are left in their care. I agree to leave my pet for DAYCARE, BOARDING, HOME CARE or GROOMING AT MY OWN RISK.  I have researched the facility an I AGREE with the environment, outside exercise and all SASSY’S PLACE policies & procedures. I understand ALL dogs/cats CAN & DO BITE; and I am aware of (1) the RISK of injury to my pet & (2) That I am responsibility for any INJURY, Physical or Financial Damages caused by my pet to another pet, person, or SASSY"S PLACE person, or facility. I will NOT hold SASSY"S PLACE or employees, responsible should an ACCIDENT, INJURY, DEATH, or LOSS of my pet occur while in their care.

MEDICAL TREATMENT:

In my absence, I give permission to SASSY’S PLACE to act on my behalf in case of an EMERGENCY or apparent health related issue. I also give my permission for my pet to be transported by car to (1) my personal veterinarian, (2) TAMU Animal Clinic for any situation that medical assistance is needed while in the care of SASSY’S PLACE. I agree to reimburse SASSY’S PLACE for all charges incurred for all medical care. I WILL NOT seek retribution from SASSY’S PLACE should an ACCIDENT, INJURY, ILLNESS, DEATH or LOSS of my pet occur during or following ANY services rendered by SASSY’S PLACE or it’s employees.  

VACCINATIONS/OVERALL HEALTH:

I hereby declare that my pet is current within the calendar year on (1) RABIES (2) DHLPPC/FDLKV (3) Bordetella Vaccinations. I understand it is the policy of SASSY’S PLACE to require proof of vaccinations by Vet Records, VET Verbal Verification, or Current Tags. I also understand that my pet is still susceptible to other illnesses due to AGE, STRESS, NUTRITION LEVELS, IMMUNE SYSTEM, AND EXPOSURE TO OTHER DOGS. I understand that SASSY’S PLACE prefers all pets be at least 6 months old, Spayed/Neutered, friendly, sociable, and clean with no Fleas/Ticks. I agree to reimburse or pay for any charges incurred by SASSY’S PLACE for my pet to adhere to these policies.

IMPORTANT DETAILS:

(1)   I understand that SASSY’S PLACE is NOT responsible for misplaced, lost, damaged or broken items.

(2)    I understand the rates, payment terms, & the hours of operation for SASSY’S PLACE

(3)   I understand that if I am NOT satisfied with the services provided by SASSY’S PLACE, that I will notify SASSY’S PLACE by the close of business the following day. (979) 220-4547

(4)   I understand that SASSY’S PLACE has the right to refuse service to any pet that is aggressive, bites, unmanageable, too loud, or NOT suited for the SASSY’S PLACE environment.

(5)   I understand that SASSY’S PLACE will not release my pet to anyone without my written consent.

SIGNED ____________________DATE _______        PETS NAME ________________