Animal Name *

Gender *

Spayed/Neutered *

Yes

No

Medicines

Allergies

Breed *

Date of Birth *

OWNER INFO

Owner First Name *

Owner Last Name *

Address 1 *

Address 2

Apt, suite, #, etc.

City *

State *

Zip *

Email *

Emergency Contact Name *

Veterinary Office Name *

Vaccine INFO

Payment Info

Preferred Method of Payment *

Name on CC *

All clients must put a cc on file to hold all appointments

Credit Card # *

All clients must put a cc on file to hold all appointments

Exp Date *

Sec Code *

Billing Street Number and Name *

Billing Zip *

MORE DETAILS

About my dog at home

Please select all that apply. And there is no need to be shy about anything on this list, we need to know as many details as possible

Crate Trained

Left free in home - unsupervised

Crated in home- unsupervised

Sleeps in my bed

Sleeps in their own bed

Sleeps in my room

Sleeps in other room

Uses a doggie door

Dog Training

Select all that apply to your dogs current education level

No Training

Puppy Class

Trained myself

Group Class- Basic

Group Class- Advanced

Sport Training (agility, herding, dock diving, protection)

No Clue- My dog is adopted

Dog Behavior

Digs

Barks at visitors

Barks at everything

Barks when I leave

Jumps fences

Breaks out of crates

Breaks out of rooms/doors/windows

Mouthy with me

Mouthy with strangers

Mouthy with children

Body Part Awareness

Feet

Tail

Hindquarter

Likes being brushed

Hates being brushed

Nail care is no problem

Nail care is a project to accomplish

Other dogs

Likes Puppies

Indifferent of Puppies

Hates Puppies

Likes low energy dogs

Likes high energy dogs

Likes Male dogs

Likes Female dogs

Hates Male dogs

Hates Female dogs

My dog LOVES every other dog

My dog is anti-social

Activity Level

Daily walk

Walk 1-3 times a day

Daily off leash run

Weekly off leash run

Couch Potato

Daily run-outdoors

Daily run- Treadmill

I walk my dog

I have a dog walker

Dog park/Daycare few times a week

Dog park/Daycare every day

Does your dog ...

Have any possessiveness over toys, food, bones?

Has your dog...

ever growled, snapped or bitten a human?

Are there...

any other pieces of information we should know about you or your pet?

My Dog is My Rock

New Client Info