PET DIRECTIVE
This Pet Directive includes important information about your Pet. It is to be used as a guide by those who have been charged with finding a loving, healthy home for your Pet if something should happen to you and/or any co-owners of the Pet. This is not a legally binding document; it’s purpose is to provide important background information on your Pet and to state your wishes regarding the Pet’s care.
• To be completed for each Pet. Please attach a photo of your Pet, if possible. • This document is for domesticated household pets only (e.g.: horses require different level of planning). • If there are multiple owners (e.g. spouses, siblings), all should sign Page 5. • Not to be used to make monetary bequests for your animal.

OWNER INFORMATION
Owner’s Name(s):
Address:
Phone Number:
City:                                                                State:                             Zip Code:
PART ONE GENERAL BACKGROUND INFORMATION
Pet’s name:
Type of Animal (e.g.: dog, cat):
Brief description and special markings: Breed: How Pet was originally obtained (e.g.: adoption, friends, breeder, rescue group): Current age of Pet: Pet is microchipped? Yes No If YES, the microchip company and contract number is: Pet has been neutered/spayed? Yes No Pet regularly wears a collar? Yes No Pet is registered with the County? Yes No If YES, the number of the registration is: Pet has sibling(s): Yes No Name of sibling(s) and type of animal: Brief description of Pet’s personality (e.g.: happy, anxious, shy): Pet Directive • Page 2 of 6 Produced by the Law Offices of Stefanie West | (510) 684-8365 | Stefanie@TrustStefanie.com | www.truststefanie.com PART TWO PET’S HEALTH HISTORY AND CONTACTS Current Veterinarian Contact Information: Name: Phone Number: Address: City: State: Zip Code: Prior Veterinarian Contact Information: Name: Phone Number: Address: City: State: Zip Code: Has the Pet been regularly vaccinated? Yes No Date / Year of Last Vaccination: Name of Pet insurance company and information, if applicable: Name: Phone Number: Address: City: State: Zip Code: Contract Number for Policy: Annual Premiums: MEDICATION Name of Medication Dosage: Purpose: Duration: Name of Medication Dosage: Purpose: Duration: Name of Medication Dosage: Purpose: Duration: Prior Surgeries: Health issues to be aware of: Pet Directive • Page 3 of 6 Produced by the Law Offices of Stefanie West | (510) 684-8365 | Stefanie@TrustStefanie.com | www.truststefanie.com PART THREE DAILY ROUINE AND MAINTENANCE Animal is on a prescription diet: Yes No Brand of food: Amount: Times daily: Favorite treats: Favorite toys: Name of Groomer: Frequency of visits to groomer: Special instructions: Exercise regimen: Pet walker – name and contact, if applicable: Pet sitter – name and contact, if applicable: This Pet is: My pet is: Indoor only My pet is: Outdoor only My pet is: Indoor/Outdoor My pet is: Kept in a crate during the day My pet is: Other, explain This Pet has use of a “doggie door” My pet is: Yes No This Pet is let out to “potty” as follows: Sleeping arrangements (e.g.: crate, owner’s bed, pet’s own bed): This Pet enjoys the following: Location of pet supplies in my home: Pet Directive • Page 4 of 6 Produced by the Law Offices of Stefanie West | (510) 684-8365 | Stefanie@TrustStefanie.com | www.truststefanie.com PART FOUR CARE FOR PET AFTER DEATH OR INCAPACITY OF OWNER(S) Temporary Care. If I/We cannot care for the Pet temporarily, the following individuals / organizations can provide short-term shelter and care for the Pet: First Choice Name: Phone number and/or email: Second Choice Name: Phone number and/or email: Permanent Home. If I/We can no longer care for the Pet permanently, My/Our Legal Agent shall offer this Pet to the following individual(s), breeder(s), or organization(s), in the order listed below: First Choice Name: Phone number and/or email: Second Choice Name: Phone number and/or email: I/We have already asked those listed above to care for the Pet upon My/Our incapacity or death(s). My pet is: Yes is No Please inform the breeder of the whereabouts of the Pet after My/Our incapacity or death(s). My pet is: Yes is No Not applicable It is possible to include instructions about your Pet in your Estate Planning Documents. I/We have included provisions about this Pet in a Will, Trust and/or Power of Attorney. My pet is: Yes, please see those documents, located (fill in location): My pet is: No, I/We have not. I/We do not know. Important Note: If you wish to leave a monetary gift for the benefit of your animal, you should formally do so in your estate documents (e.g.: Will, Trust, Power of Attorney) to be valid. You should not attempt to make a bequest to your animal in this document. This document should not conflict with your estate planning. Pet Directive • Page 5 of 6 Produced by the Law Offices of Stefanie West | (510) 684-8365 | Stefanie@TrustStefanie.com | www.truststefanie.com PART FIVE GUIDANCE FOR FINDING A NEW HOME Please circle where applicable on the numbered scale. The number “1” means “Do Not Agree,” the number “5” means “Strongly Agree”. This Pet gets along well with children 1 2 3 4 5 Don’t know This Pet would prefer a quiet home 1 2 3 4 5 Don’t know This Pet should be kept with his/her sibling(s) 1 2 3 4 5 Not applicable Access to a yard is important for this Pet 1 2 3 4 5 Not applicable This Pet needs daily exercise 1 2 3 4 5 Not applicable This Pet should not be placed in a home with other pets 1 2 3 4 5 Don’t know PART SIX END OF LIFE CARE FOR THE PET At the Pet’s death, the animal is to be: My pet is: Cremated My pet is: Buried in a Pet Cemetery or other location an animal is legally allowed to be buried If Pet is to be cremated, ashes are to be: At the end of this Pet’s life, the decision-maker for the Pet (check all that apply): Should aggressively attempt surgeries and treatments to keep the Pet alive in an attempt to improve health. Should not prolong the Pet’s life if he or she is in pain, the expected benefits of treatment are outweighed by the risks, the anticipated quality of life is poor and is not expected to improve. The following treatments should NOT be tried, even if failure to try them may hasten the Pet’s death: My pet is: Chemotherapy My pet is: Blood Transfusion My pet is: Resuscitation OWNER(S) SIGNATURE(S) Name: _________________________________________________________________________________________________________________________ Date: ______________________________ Print Name: ______________________________________________________________________________________________________________ Name: _________________________________________________________________________________________________________________________ Date: ______________________________ Print Name: ______________________________________________________________________________________________________________ Pet Directive • Page 6 of 6 Produced by the Law Offices of Stefanie West | (510) 684-8365 | Stefanie@TrustStefanie.com | www.truststefanie.com