Enrollment Form

Contact info

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Work phone

Cell or home phone*

Referred by*

Name / phone*

Please specify*

Emergency contact- Other than yourself

Name

First Last

Home phone

Work phone

Cell phone

Pet information

Name*

Breed*

Sex*

Age*

Weight

Spayed/Neutered?*

Veterinarian

Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Pet personality profile

Is your dog treated for fleas/ticks?*

Is your dog treated with a heartworm preventative?*

Is your dog up to date on all shots/immunizations including bordetella (kennel cough)?*

Is your dog currently taking any medications or supplements?*

If yes, please list what for and the dosing instructions:

Does your dog have hip dysplasia?*

If yes, what restrictions need to be placed on your dog’s activities or movements?

Does your dog allow brushing?*

Nail clipping?*

Does your dog appear afraid of any specific items or noises?*

If yes, please explain:

How does your pet react to strangers coming into your home or yard?

Does your dog ever bark or growl at anyone passing outside of your home or yard?

Are there any people your dog automatically fears or dislikes?

Are there any dogs your dog automatically fears or dislikes?*

How does your dog react to puppies?*

Has your dog ever growled at someone?*

If yes, please explain:

Has your dog ever bitten someone?*

If yes, please explain:

Does your dog have problems with any of the following areas? If yes, please explain.

Other:

Has your dog ever growled or snapped at someone who has taken his/her food or toys away? If yes, what were the circumstances?

Has your dog ever shared his/her food or toys with other animals?

Does your dog play with other dogs?

Has your dog ever had formal obedience training? If yes, where?

What commands does your dog know?

Other comments about your dog you feel may be helpful.

Comments

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Contact info

Emergency contact- Other than yourself

Pet information

Veterinarian

Pet personality profile