Name of client: _______________________________________________________

Name of cat: __________________________________________________________

Age: _______ Breed: ______________ Sex: F/M

Spayed ___Yes ___No Neutered ___Yes ___No

Colour: ____________ Markings: _____________________ Weight: _______

Rabies tag #: ________ Date of Vaccination: _________ 1 or 3 year shot

1. Plays with toys YES / NO

2. Won't eat when stressed YES / NO

3. Is skittish YES / NO

4. Is allowed on furniture YES / NO

5. Tries to escape through doors/windows YES / NO

6. May be given treats YES / NO

7. Defecates outside of litter box? YES / NO

Favourite place? ____________________________________________________

8. Is afraid of thunder, fireworks or other loud noises YES / NO

9. Gets into garbage YES / NO

10. Has other fears YES / NO

11. Enjoys cuddling YES / NO

12. Favourite hiding places? YES / NO

13. Has allergies? YES / NO If so, to what?

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14. Does the cat show any other signs of aggression? YES / NO

14a. If yes to the above what are the triggers? Reactions?

15. Has the cat ever bitten anyone? YES / NO If yes,

Why? Additional comments:

_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

Does your cat have a favourite game? _______________________________________________________________________

Cat's background (i.e. adopted from pound, purchased as a kitten etc.): _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

Medical history:

_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

Brand of food - Specify kibble, canned, cooked or raw: _______________________________________________________________________

Specific feeding instructions:

_______________________________________________________________________

Emergency contact information:

Name: ________________________________________________________________

Relationship To Client: _______________________________________________

Address: ______________________________________________________________

Phone Number: _______________________________________________________

Veterinarian information:

Name of Vet: _________________________________________________________

Name of Clinic: _______________________________________________________

Address: ______________________________________________________________

Phone Number: _______________________________________________________

Special Instructions:

________________________________________________________________________ ________________________________________________________________________

I, the client, certify that the above is true and complete to the best of my knowledge.

I` will notify T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service of any changes in writing prior to the commencement of any service period.

Client Name, Printed ________________________________________

Client Name, Signature ______________________________________

Date: ___________________________________