My Pet's Plan B - 1 Pet Solution
The information herein is accurate to the best of my knowledge. In the case of my untimely death or incapacity, I hereby outline my wish for the short or long term care of my pet. I will provide all the necessary information for designated caregivers. I understand that circumstances of my designated caregivers, whether temporary or permanent, may change in the course of time and that it is my responsibility to contact them once or twice each year to ensure they are willing and able to carry out my wishes, as agreed and described in this document.
My Information
Full Name
*
Prefix
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
-
Area Code
Phone Number
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
My Veterinarian and Professionals
Veterinarian Name
Veterinarian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veterinarian Phone
-
Area Code
Phone Number
Boarding Facility
Boarding Facility Address
Boarding Facility Phone Number
-
Area Code
Phone Number
Groomer Used
Groomers Address
Groomers Phone Number
-
Area Code
Phone Number
Day Care Used
Day Care Address
Day Care Phone Number
-
Area Code
Phone Number
Pet Sitter Used
Pet Sitter Address
Pet Sitter Phone Number
-
Area Code
Phone Number
Pet #1
Pet #1's Name
*
Pet #1's Species
*
Please Select
Dog
Cat
Rabbit
Bird
Reptile
Horse
Other
Pet #1's Gender
Male
Female
Is Pet #1 Spayed or Neutered?
*
Yes
No
Pet #1's Spay/Neuter Date
-
Month
-
Day
Year
Date Picker Icon
Pet #1's Secondary Breed
Pet #1's Primary Breed
Pet #1's Spay/Neuter Date Provided is
Actual
Estimate
Pet #1's Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Pet #1's Date of Birth Provided is
Actual
Estimate
Pet #1's Weight
Pet #1's Microchip Number
Pet #1's Current Photo #1
Pet #1's Current Photo #2 (optional)
Pet #1 Ownership Paperwork (ie birth certificate, adoption agreement, etc
Pet #1 Vaccination Records
Pet #1 Vaccination Records 2
Pet #1 Vaccination Records 3
Is the Pet #1 Housetrained?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Get along with human adults?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Get along with human children?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Get along with other pets?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Accept Affection?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Vocalize?
Choose One
Never
Sometimes
Usually/Often
Always
Is Pet #1 Nocturnal?
Choose One
Never
Sometimes
Usually/Often
Always
Is Pet #1 Food Aggressive?
Choose One
Never
Sometimes
Usually/Often
Always
Is Pet #1 Timid?
Choose One
Never
Sometimes
Usually/Often
Always
Is Pet #1 Social?
Choose One
Never
Sometimes
Usually/Often
Always
Pet #1 Behaves off leash?
Choose One
Never
Sometimes
Usually/Often
Always
Doesn't Apply
Pet #1 Comes when called?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Hide?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Fear loud noises?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Escape from enclosures?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Exhibit anxiety?
Choose One
Never
Sometimes
Usually/Often
Always
Does Pet #1 Urinate when excited?
Choose One
Never
Sometimes
Usually/Often
Always
Please use this area to list any additional personality information for Pet #1:
Does pet #1 require daily exercise?
yes, see description below
no
Pet #1's Exercise Needs, preferences, frequency and duration
Has Pet #1 had formal training
yes
no
If yes, what type of training for Pet #1?
Pet #1's Date of Training Completion
Pet #1 Training Documentation/Certificates
Does pet #1 have any known medical conditions?
yes
no
Please describe Pet #1's medical condition(s) here:
Does pet #1 take medication for any medical conditions?
yes
no
Please list Pet #1's medications and dosage information here:
Does pet #1 take any preventative medications? (ie Heartworm prevention, flea/tick prevention)
yes
no
Please list Pet #1's preventative medications and dosage schedule here:
Does pet #1 have any previous surgery or injury wounds, scars, or tender areas?
yes
no
Please describe Pet #1's previous surgery or injury here:
Eating Habits
Brand of Food Given
Frequency of Feedings
Local Store where food can be purchased
Brand of Treats Given
Frequency of Treats
Local Store where treats can be purchased
Please list any additional feeding information here
Pet Insurance
Do any of your pets have medical insurance?
yes
no
Name of Medical Insurer
Insurer Phone number
Insurer Policy Number
Please list any additional medical insurance information here
Pet Financial Needs
What are the monthly budgetary needs of your pet?
I have provided for these budgetary needs?
yes
no
Attach Budget Here (optional)
Please list the executor of your will and their contact information. (optional)
Temporary CareGiver Options for my pets
Temporary CareGiver #1
*
Temporary CareGiver Email
*
example@example.com
Temporary CareGiver Phone Number
-
Area Code
Phone Number
Temporary CarGiver Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Temporary CareGiver #2
Temporary CareGiver #2 Phone Number
Temporary CareGiver #2 Email
Temporary CareGiver #2 Address
Permanent CareGiver Options for my pets
First Choice Permanent Caregiver Name
*
First Choice Permanent CareGiver Email
*
example@example.com
First Choice Permanent CareGiver Phone Number
-
Area Code
Phone Number
First Choice Permanent CareGiver Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Second choice Permanent Caregiver Name
Second choice Permanent CareGiver Phone Number
Second choice Permanent CareGiver Email
Second choice Permanent CareGiver Address
Third choice Permanent Caregiver Name
Third choice Permanent CareGiver Phone Number
Third choice Permanent CareGiver Email
Third choice Permanent CareGiver Address
Today's Date
-
Month
-
Day
Year
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