Dog Name
*
First Name
Last Name
Desired Start Date
Select Location
*
Client Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Phone
*
(###)
###
####
Emergency Contact and Relationship
First Name
Last Name
Relationship
Emergency Contact Phone
(###)
###
####
How did you first hear about The Dog Den
Dog Breed(s)
Color/Description
Male/Female
Male
Female
Birthdate
MM
DD
YYYY
Spayed/Neutered
Yes
No
Where did you get your dog?
Name of breeder, rescue, or other
How long has your dog been in your family?
If adopted, do you have any knowledge of your dog's past history?
Treating Veterinarian
Vet Clinic Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Vet Clinic Phone
(###)
###
####
Rabies Due
MM
DD
YYYY
DHLPP Due
MM
DD
YYYY
Bordatella Due
MM
DD
YYYY
Fecal Test Due
*
MM
DD
YYYY
Describe any medical/health issues we need to be aware of (i.e. seizures, heart, hip problems, etc.)
List any known allergies
*
Food, environmental, etc
Describe your dog's feeding schedule/eat habits
How often, how much, treats
What are your dog's sleeping habits
Location and how often?
Please list the number of adults and children (under 18) that live with your dog
Please list the other animals that live in your home: names, ages, sex and species
Please list the training classes your dog has attended
Type, Level, and Location
Please list the cues your dog is familiar with
What does your dog do when someone reaches for his/her bone, food or toys?
how does your dog play with other dogs?
Check all that apply
Does your dog prefer certain sexes of dogs?
Male
Female
No Preference
What are some of your dog's favorite things?
Food, toys, fetch, water, pets, etc.
What are some of your dog's favorite activities?
Fetch, tug, running, swimming, shredding, digging, barking, chasing, etc.
List some of the things your dog is afraid of or dislikes.
Loud noises, sudden movements, children, umbrellas, etc.
What does your dog do when he/she is afraid or upset?
Please list the exercise your dog receives regularly
Please list the training your dog receives regularly
Is your dog comfortable in a crate/confinement area?
If no, please describe what they do if they are confined
How does your dog react to being handled in areas such as feet, tail, mouth, ears, etc?
Has your dog ever escaped or jumped a fence?
If yes, please describe the situation
How does your dog react to puppies?
How does your dog react to strangers?
Does your dog automatically dislike any kind of dog?
Does your dog automatically dislike any kind of person?
Please list any behavioral problems/idiosyncrasies/special sensitivities we should be aware of
How often do you think you would like to use the daycare service?
Why are you looking to use our daycare services?
Socialization? Energy Release? Work Long Hours? Separation Issues? Other?
