Service Animal Disaster Information Form
From Service Dog Training
While service animals are required to be allowed to accompany their handlers during evacuations and into disaster shelters, the reality is that there will occasionally be situations where a handler must be separated from their service animal. In those situations, it is best to be prepared to give all necessary instructions on your animal's care to those that will be sheltering it. This form can help you as you collect the information that a rescuer would need to care for your service animal.
I carry this information with me when I travel and have another copy in my dog's disaster kit. I recommend placing this information in a plastic bag or some other waterproof container to make sure it doesn't get damaged.
This form is also available as a PDF. Service Animal Information Sheet for Emergencies
An alternate way of providing this information to disaster personnel is to put it in a narrative form. Here is a sample of what that would look like, using my dog as the example. Service Animal Information Narrative
I encourage the reproduction of this form for personal and educational purposes. If you are using it in a class or as part of an informational packet, please give appropriate credit.
IN CASE OF EMERGENCY
________ is a tasked trained service animal who performs tasks to mitigate the effects of my disability. If we are separated in an emergency situation, please refer to this document for care instructions for _______. It is important to return this animal to its owner as soon as possible.
Description
Breed: _______________________________________________________________
Sex: M/F Spayed/Neutered: Y/N
Age/Date of Birth: _______________________________________________________________
Weight: _______________________________________________________________
Primary Color(s):______________________________________________________
Detailed Markings:______________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________
Microchip: Y/N
Brand of Microchip: __________________ Chip #:_______________
Tattoo: Y/N Tattoo Description: _______________________________________________________________
Animal is registered with a pet recovery service: Y/N Service: _______________________
Other identification markings:______________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________
Medical and Health Information
Veterinarian Information: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _____________________________________________
Vaccinations: Up to date/Out of Date
Date of vaccinations__________ If out of date, why? _______________________________________________________________ _______________________________________________________________ ______________________________
Known medical problems and significant health history: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _____________________________________________
Currently taking medications: Y/N
If yes, see attached medication list.
Food Allergies/Intolerances: Y/N Describe: _______________________________________________________________ _______________________________________________________________ ______________________________
Medication Allergies/Intolerances: Y/N Describe: _______________________________________________________________ _______________________________________________________________ ______________________________
Other Allergies: Y/N Describe: _______________________________________________________________ _______________________________________________________________ ______________________________
Temperament and Training
Aggressive to people: Y/N Details on any aggression towards people: _______________________________________________________________ _______________________________________________________________ ______________________________
Aggressive to dogs: Y/N Details on any aggression towards dogs: _______________________________________________________________ _______________________________________________________________ ______________________________
Aggressive to cats: Y/N Details on any aggression towards cats: _______________________________________________________________ _______________________________________________________________ ______________________________
Aggressive to children: Y/N Details on any aggression towards children: _______________________________________________________________ _______________________________________________________________ ______________________________
Can be housed with other dogs: Y/N
Can only be housed with certain dogs Y/N
Describe circumstances for housing with other dogs: _______________________________________________________________ _______________________________________________________________ ______________________________
Stressors/Fears: _______________________________________________________________ _______________________________________________________________ ______________________________
Usual response to stressors: _______________________________________________________________ _______________________________________________________________ ______________________________
Ways of controlling stressors/fears: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _____________________________________________
Housebroken: Y/N Crate Trained: Y/N
Emergency Contacts
If I must be separated from my service animal, or if he/she is found without me, contact the following individuals in the order listed below. These people are permitted to make decisions regarding ________ in the event I cannot be reached. We will be financially responsible for his care.
__________(Owner): (___)___-____ (Home) (___)___-____ (Cell) (___)___-____(Work)
__________(Local Contact) (___)___-____ (Home) (___)___-____ (Cell) (___)___-____(Work)
__________(Out of area) (___)___-____ (Home) (___)___-____ (Cell) (___)___-____(Work)
__________(Alternate) (___)___-____ (Home) (___)___-____ (Cell) (___)___-____(Work)
__________(Alternate) (___)___-____ (Home) (___)___-____ (Cell) (___)___-____(Work)
Images
I recommend that you attach clear photos of your service animal to this form, ideally both a front and side view.
Medications
The medication sheet will open as a PDF.
