Noah's Ark Vet - ADVANCED DIRECTIVE PET PROFILE (FIDO’S FORM)

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Date
Owner’s Name
Owner’s Address
Email Address
Home Number
Cell Number
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In an emergency or if you are incapacitated, who would know how to take action for your pets? Help others take care of your pet as you would. Complete this profile and keep it with your Advanced Medical Directives, Will, and storm evacuation kit. Your pet’s information should be available to first responders and designated pet caregivers. Be sure to include it with the “File Of Life” kit provided free of charge by rescue squads for placement on refrigerators. If you don’t have a File Of Life, place a note on the refrigerator where to find this document in your home. Give a copy to your designated Power of Attorney, your attorney, your vet and anyone else you authorize to assist on your behalf.

PET EMERGENCY CONTACT INFORMATION
If I am unable to take care of my pet either temporarily or permanently, please contact the following person(s) to take immediate control and care of my pet(s):
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FIRST CONTACT
Name
Cell Phone
Home Phone
Relationship or Title
Email
Yes
No
Has key?
Home Address
4
Does this person have your express permission to do the following
Yes
No
Enter your home?
Yes
No
Care for your pet in your home?
Yes
No
Care for your pet at their home?
Yes
No
Take the pet to a veterinarian office or boarding facility for boarding and/or medical care?
5
ALTERNATE CONTACT
Name
Cell Phone
Home Phone
Relationship or Title
ALTERNATE CONTACT EMAIL
Yes
No
Has key?
Home Address
6
Does this person have your express permission to do the following
Yes
No
Enter your home?
Yes
No
Care for your pet in your home?
Yes
No
Care for your pet at their home?
Yes
No
Take the pet to a veterinarian office or boarding facility for boarding and/or medical care?
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Owner Signature
Clear
8
TOTAL NUMBER OF PETS IN THE HOME
Cats
Dogs
Birds
Other
9
PET’S NAME
Yes
No
HEARING IMPAIRED?
Yes
No
BLIND?
Yes
No
MOBILITY ISSUES?
Yes
No
DIABETES?
Yes
No
FELINE LEUKEMIA?
Yes
No
ALL SHOTS CURRENT?
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DESCRIPTION
Cat
Dog
Bird
Other
Species
If Other, Please Specify
Breed
Age/Birthdate
Yes
No
Microchip
Microchip #
Yes
No
Neutered or Spayed?
Yes
No
Declawed?
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Yes
No
Indoor Only?
Yes
No
Part time Outdoor?
Yes
No
Mostly Feral?
12
PHYSICAL DESCRIPTION(Unusual markings, unique identifiers)
13
Approximate Weightlbs
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VETERINARIAN CONTACT INFORMATIONPrimary Vet
Company Name
Vet’s Name
Phone
Address
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VETERINARIAN CONTACT INFORMATIONSpecialist/Other Vet
Company Name
Vet’s Name
Phone
Address
Where in the home are your pet’s medical records kept?
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CURRENT MEDICAL TREATMENTCurrent Medications
Drug Name
Dosage
Frequency
Condition Being Treated
Where is your pet’s medicine kept?
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Current Medical Conditions (Not Treated With Medication)
Condition
How Treated?
Frequency?
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Dry FOOD#1
Brand
Flavor
Daily Amount
Feeding Times
Open or Controlled?
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Dry FOOD#2
Brand
Flavor
Daily Amount
Feeding Times
Open or Controlled?
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Wet FOOD#1
Brand
Flavor
Daily Amount
Feeding Times
Open or Controlled?
21
Wet FOOD#2
Brand
Flavor
Daily Amount
Feeding Times
Open or Controlled?
22
Snacks/Treats FOOD#1
Brand
Flavor
Daily Amount
Feeding Times
Open or Controlled?
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Snacks/Treats FOOD#2
Brand
Flavor
Daily Amount
Feeding Times
Open or Controlled?
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Special Needs/Comments
Food aggressive?
Food guarding?
Finicky?
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Comments
26
POTTY HABITS
Any litter box issues, type/brand of litter used, habitual potty accidents, related issues
Times of day usually walked
27
DAILY LIVING SPACE
28
How many hours daily is your pet left alone? Where does he/she spend most of the day. Caged? Garage? Fenced Yard? Throughout house? Does your pet attempt to escape from his/her usual habitat? If so, all the time or only when left alone? Will he/she try to climb on counters? Destroy property if uncaged when alone?
29
Is your pet use to a home that isActive, Quiet, has small children, has lots of private space, strict discipline or more relaxed, predictable schedule or more spontaneous?
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What other animals has your pet lived with in your home? How do/did they get along?
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SOCIALIZATION
32
Is he/she in a bonded pair? Could they be separated without emotional harm?
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What types of animals or people does your pet prefer? What types of animals/people does your pet NOT get along with? People in uniform? Men? Small children? What types of animals/people does your pet chase? Snap at? Show aggression towards?
34
Under what circumstances would your pet become uncomfortable enough to flee or fight?
35
Has your pet ever bitten anyone or harmed another animal? Circumstances?
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PERSONALITY/CHARACTER/HABITS
37
Generally describe your pet’s personality(laid back, vocal, quiet, high energy, loyal only to owner, lap cat, loner, hates exercise, shy, extrovert, aggressive, likes athletic play, gentle play)
38
FAVORITE TOYS AND GAMES (yes, we know, snacktime!)
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MY PET’S SPECIAL SKILLS/TALENTS (obedience trng, service dog trng, tricks, responds to which commands)
40
MY PET’S SPECIAL SKILLS/TALENTS(obedience trng, service dog trng, tricks, responds to which commands)
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EARLY EXPERIENCES AFFECTING BEHAVIOR/HEALTH (abuse, neglect, found as stray, how long lived with you, previous Show animal. If adopted or purchased, add Contact Info on last page.
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YOUR WISHES FOR YOUR PETS CAREWhile you are incapacitated or in the case of your death?
Current caregiver as long as possible.
Board as long as possible.
As soon as possible Rehome through shelter (Name)
Other Action
43
This Advanced Directive Pet Profile (aka Fido’s Form©) was created by Lin and may not be sold or copied in whole or part without permission. It is provided free to all pet rescue agencies for free distribution and to pet owners for personal use. If you find it helpful, please encourage others to complete it on behalf of their pets.
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Additional Contact Information
45
Pet Sitters/Caregivers
Name
Cell Phone
Home Phone
Relationship
Email
Yes
No
Has key?
Address
46
Power of Attorney
Name
Cell Phone
Home Phone
Relationship
Email
Yes
No
Has key?
Address
47
Attorney
Name
Cell Phone
Office Phone
Relationship
Email
Firm Name and Address
48
If Adopted or From Breeder or Individual
49
Organization/Name
Phone
Email
Address
Anything else that would help provide your pet with the best possible care?
50
Signature* This field is required.
Clear
Should be Empty:

DAILY LIVING SPACE

SOCIALIZATION

PERSONALITY/CHARACTER/HABITS

Additional Contact Information

If Adopted or From Breeder or Individual