Pet Emergency Information

PLACE CURRENT PHOTO HERE Pet’s Name/Breed: _______________________________

Color/Markings: _________________________________

DOB/Height/Weight: _____________________________

Vaccine Exp. Dates: ______________________________

Visit caninestein.blogspot.com! Known Medical Issues: ___________________________

Sig. Personality Traits: ____________________________

Owner Name & Address: My Regular Veterinarian Is:

___________________________________ _____________________________________________________

___________________________________ _____________________________________________________
My pet is insured with: ________________________
___________________________________
Phone Numbers: In the event of an emergency where I am unable to attend to my animal,
___________________________________ please contact the authorized agent(s) listed on this form. If unable to
reach an authorized agent, please take my pet to the nearest veterinarian or
___________________________________ professional boarding facility for safe keeping until an agent can be
Authorized Agents Name/Phone#: reached. Owner and/or authorized agents gaurantee all expenses. Thank
you for looking after my pet!
___________________________________
___________________________________ Signed: ___________________________________ Date: _____________
These people are fully authorized to care for my animals in my absence.