Owner's Name *

Referred By:

Home Phone *

Cell Phone *

Work Phone:

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Email *

Date of birth *

Address *

Emergency Contact 1: *

Emergency Contact 1 Phone: *

Emergency Contact 2: *

Emergency Contact 2 Phone: *

Vet's Office *

Vet's Office Phone *

Vet's Name: *

Vet's Phone: *

Address of Vet's Office

Dog's Name *

Dog's Breed *

Dog's Age *

Dog's Gender *

Current Medications:

Important Medical History Notes:

Reason(s) for Meds:

Dog's Regular Food: *

Feeding Amount/Times of Day: *

How Much per Feeding?
How Many Times per Day?
Special Instructions

Additional Notes: *

Dog's Regular Treats: *

Other treats okay? *

Treat/Dietary Restrictions:

Medicine:

Amount of Medicine:

Time for Medicine:

Notes for Medicine:

Medicine 2:

Amount of Medicine 2:

Time for Medicine 2:

Notes for Medicine 2:

Exercise Frequency:

Modes of Exercise:

Exercise Duration:

Additional Health Care Notes:

Known Behavioral Issues:

Special Notes regarding Behavioral Issues:

Special Training Requested:

Does your dog obey commands?* *

Has your dog been trained before?* *

If yes, please list where and when:

Is your dog house trained?* *

Has your dog ever been in a fight?* *

If yes, please give details:

Does your dog do this to dogs/humans/children:* *

If so, please specify:

Has your dog bit another dog, human, or child?*

If yes, please specify:

Does your Dog let you groom them / touch their nails?*

Does your dog let you put on/take off collars?*

Does your dog go into the crate?*

Does your dog bark or growl in the crate?*

Does dog react negatively to touching/petting?*

Does your dog have separation anxiety?*

Dog aggressive when people approach their food?*

Dog aggressive when people try to take toy away?*

Does dog growl when you move them off furniture?*

Does your dog have accidents in the crate?*

Does your dog have high prey drive?*

Has your dog injured or killed small animals?*

Any additional details about dog's behavior:*

Picture of Your Dog

Proof of Vaccinations

Do You Have A Second Dog To Fill Out? *

Dog's Name (2) *

Dog's Breed (2) *

Dog's Age (2) *

Dog's Gender (2) *

Current Medications (2):

Reason(s) for Meds (2):

Important Medical History Notes (2):

Amount/Times of Day* (2): *

Dog's Regular Food* (2): *

Additional Notes* (2): *

Dog's Regular Treats* (2): *

Other treats okay?* (2): *

Treat/Dietary Restrictions (2):

Medicine 1 (2):

Time for Medicine 1. (2):

Amount of Medicine 1 (2):

Notes for Medicine 1 (2):

Medicine 2 (2):

Amount of Medicine 2 (2):

Time for Medicine 2 (2):

Notes for Medicine 2 (2):

Exercise Duration (2):

Modes of Exercise (2):

Exercise Frequency (2):

Additional Health Care Notes (2):

Known Behavioral Issues (2):

Special Notes regarding Behavioral Issues (2):

Special Training Requested (2):

Does your dog obey commands?* (2): *

If yes, please list where and when (2):

Is your dog house trained?* (2): *

Has your dog been trained before?* (2): *

Has your dog ever been in a fight?* (2): *

If yes, please give details (2):

Does your dog do this to dogs/humans/children (2):

If so, please specify (2):

If yes, please specify (2):

Dog let you groom them / touch their nails? (2)* *

Does your dog go into the crate? (2)* *

Does your dog bark or growl in the crate? (2)* *

Does dog react negatively to touching/petting? (2)* *

Does your dog have separation anxiety? (2)* *

Dog aggressive when people approach their food? (2)* *

Does your dog let you put on/take off collars? (2)* *

Dog aggressive when people try to take toy away? (2)* *

Does your dog have accidents in the crate? (2)* *

Does your dog have high prey drive? (2)* *

Has your dog injured or killed small animals? (2)* *

Does dog growl when you move them off furniture? (2)* *

Any additional details about dog's behavior (2)* *

Picture of Your Dog (2)

Proof of Vaccinations (2)

Do You Have A Third Dog To Fill Out? *

Dog's Name (3) *

Dog's Breed (3) *

Dog's Gender (3) *

Dog's Age (3) *

Current Medications (3):

Reason(s) for Meds (3):

Important Medical History Notes (3):

Dog's Regular Food* (3): *

Amount/Times of Day* (3): *

Additional Notes* (3): *

Dog's Regular Treats* (3): *

Other treats okay?* (3): *

Medicine 1 (3):

Amount of Medicine 1 (3):

Time for Medicine 1 (3):

Notes for Medicine 1 (3):

Treat/Dietary Restrictions (3):

Medicine 2 (3):

Time for Medicine 2 (3):

Amount of Medicine 2 (3):

Notes for Medicine 2 (3):

Exercise Duration (3):

Exercise Frequency (3):

Modes of Exercise (3):

Additional Health Care Notes (3):

Known Behavioral Issues (3):

Special Notes regarding Behavioral Issues (3):

Does your dog obey commands?* (3): *

Special Training Requested (3):

Has your dog been trained before?* (3): *

If yes, please list where and when (3):

Is your dog house trained?* (3): *

Has your dog ever been in a fight?* (3): *

If yes, please give details (3):

Does your dog do this to dogs/humans/children (3):

If so, please specify (3):

Does your dog let you put on/take off collars? (3)* *

Does your dog go into the crate? (3)* *

Does your dog bark or growl in the crate? (3)* *

Dog let you groom them / touch their nails? (3)* *

Does dog react negatively to touching/petting? (3)* *

Dog aggressive when people approach their food? (3)* *

Does your dog have separation anxiety? (3)* *

Dog aggressive when people try to take toy away? (3)* *

Does dog growl when you move them off furniture? (3)* *

Does your dog have accidents in the crate? (3)* *

Has your dog injured or killed small animals? (3)* *

Does your dog have high prey drive? (3)* *

Picture of Your Dog (3)

Proof of Vaccinations (3)

Any additional details about dog's behavior (3)* *