New Customer Form

Feel free to browse our full customer agreement. During our first consultation, we'll bring a printed copy for you to sign.

* Denotes Required Field

Your Information

Your First Name:
Your Last Name:
Address:
City:
Zip Code:
Email:
Home Phone:
Cell Phone:
Work Phone:

Emergency Contact 1

Name:
Home Phone:
Cell Phone:
Work Phone:

Emergency Contact 2

Name:
Home Phone:
Cell Phone:
Work Phone:

Emergency Contact 3

Name:
Home Phone:
Cell Phone:
Work Phone:

Pet Information

How many pets do you have?:

Pet 1 Info

Pet Full Name: Your pet's first and last name.
Age: Your pet's age
Sex:
Type:
Breed:
Color Markings:
Spayed or Neutered?:
Dog License Number:
Health Issues?: Let us know if your loved one has any health issues we should be aware of.

Pet 2 Info

Pet Full Name: Your second pet's first and last name.

Age: Your second pet's age.

Sex:

Type:

Breed:

Color Markings:

Spayed or Neutered?:

Dog License Number:

Health Issues?: Let us know if your 2nd loved one has any health issues we should be aware of.

Pet 3 Info

Pet Full Name: Your third pet's first and last name.

Age: Your third pet's age.

Sex:

Type:

Breed:

Color Markings:

Spayed or Neutered?:

Dog License Number:

Health Issues?: Let us know if your 3rd loved one has any health issues we should be aware of.

Pet Food Info

Location?: Where is the pet food located?
Amount?: How much food should he/she receive each feeding?
Frequency?: How often does he/she get fed?
Food Notes: Any other pet food / feeding related notes?

Pet Habits

Going outside: Does he / she have problems going outside in bad weather?
Playtime activities?:
Favorite toys?:

Dogs - Walks

Leash trained?:
Leash location:
Walk area: Where do you generally walk your dog?

Poop-bags?: Where do you keep plastic bags to use to pick up solids while walking your dog?
Waste disposal: Where do you put the “used” plastic bags?

Dogs - Interaction with Others

People avoidance: Are there any animals or people your pet should stay away from?
Stranger issues: How does he / she react to strangers?
Past Attacks: Has he / she ever attacked anyone?

Cats

Litter box: Litter box location?
Litter liner: Do you use a liner in the litter box? If so,where do you keep them?
Litter disposal: Where do would you like us to dispose of the used litter?
Change Frequency: How often do you change the litter?

Accidents & Clean-up

Accidents: Does your pet ever have accidents on the floor / carpet?

Clean up: How do you clean up the mess?

Home Information

Others at home?: Are there other stay-at-home family members?
Who else has access to your home?:
Other workers?: Who may be in the home while service is being provided?

Security Info

Do you have an alarm system?:
Where is it located?:
How is it activated?:
How is it deactivated?:
Gate code?: If applicable, what is your gate code?

Home Care - Pet Sitting

Extra services requested: Please indicate the following services you would like performed in your absence.
Shades/Drapes: Which shades/drapes should be closed in the evening and opened in the morning?
Lights: Which lights should be turned on in the evening and off in the morning?
Newspapers: If you would like your newspapers brought in, where would you like them placed?
Mail: If you would like your mail brought in, where would you like it placed?

Vet Information

Veterinarian:
Address:
City:
Phone:
Phone: If known..

Medication Info

Do your pets take any medication?:

Medication 1 Info

Medication Name:

Purpose:

Dosage:

Frequency: How many times per day?

Times: At what times during the day is the medication given?

Type:

Administration: How do you usually give the medication to your pet?

Medication 2 Info

Medication Name:

Medication Purpose:

Dosage:

Frequency: How many times per day?

Times: At what times during the day is the medication given?

Medication Type:

Administration: How do you usually give the medication to your pet?

Misc

Extra Info?: Is there any other information about your pet that would be helpful for us to know about?
Do you agree to the terms of the customer agreement?:
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Review Blurbs

Audrey has been simply wonderful!!! She walks my dog Rooney x5 per week. It's great to have the peace of mind.

- Tina

Jake and Audrey have both dogsat for us in our home, and taken our pit-shepherd mix into their home for a weekend, and we couldn't be happier. When we come home after a trip, our dogs are energetic, well-rested, and joyful.

- Tom and Jenny

We love more than anything when we get awesome, unsolicited testimonials regarding the local businesses we like to recommend. Kudos to you, Audrey, and your great business practices. We get great reviews on you guys ALL the time!

- Mike, owner of Premier Pet Supply

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