Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Tell us about members of the new pet’s household (check all that apply):

We have one or more dog(s)

We have one or more cat(s)

We have one or more small animal(s)

We have kids/kids frequently visit our home

We’ll explain this new pet’s medical history and behavioral history. Check additional topics you’d like to discuss:

Feeding this pet

House-training/litter box training

Grooming/nail trimming

Exercise, toys and fun activities

Pet proofing your home

Finding a trainer

Introducing this pet to other pets

Introducing this pet to children

Microchips and other ID options

Finding a veterinarian

Declawing

Crate-training

Moving with pets

Pulling on-leash

Flea/tick prevention

Heartworm prevention

Managing scratching behaviors in cats

Mouthing behaviors in dogs

FIV

Heartworm disease in dogs

Housing this pet

Extra services and opportunities; check all you are interested in:

Supporting us with financial or in-kind donations

Volunteering with us

Fostering with us

Low-cost spay and neuter services and other veterinary services

Low-cost microchip clinic for current pets

Training class recommendations

Name of alternate contact for your pet’s microchip registration (if applicable):

First Name

Last Name

Phone of alternate contact for your pet’s microchip registration (if applicable):

(###)

###

####