Intake Form
First name*
Last name*
Email address*
Additional Owner:
Street Number*
Apartment*
City*
ZIP*
Phone number*
Additional Number
How did you find us?*
If referred, please include name of owner and/or dog
Veterinarian Name
Veterinarian Number
Dog #1 Name*
Dog #1 Breed*
Dog #1 Age*
Dog #1 Birthday*
Dog #1 Color*
Dog #1 Weight*
Dog #1 Gender*
Male
Female
Dog #1 Condition*
Spayed/Neutered
Unaltered
Any health issues?*
Yes
No
If yes, please explain:
Where was dog #1 obtained
Where does dog #1 sleep
Crate
Couch
Bed
On floor
Where is dog #1 kept when gone
Crate
Room
Loose in house
Outside
Any previous training for dog #1, if so please elaborate
Does your dog struggle with*
Jumping
Pulling on leash
Leash reactivity
Not coming when called
Counter surfing
Fearfulness
Attacking humans
Nipping
Anxiety
House breaking
Destruction of property
Excessive barking or whinning
Riding in the car
Crating
Hyperactivity
Darting out doors
Staying when asked
Attacking dogs
Social Information*
Good with other dogs
Good with other people
No bite history
Has dog issues
Has people issues
Has bitten a person
Has bitten a dog
Please elaborate*
Main goals to accomplish with dog #1*
Do you have any other dogs you'd like to add?*
Yes
No
Dog #2 Name
Dog #2 Breed
Dog #2 Age
Dog #2 Birthday
Dog #2 Color
Dog #2 Weight
Dog #2 Gender
Male
Female
Dog #2 Condition
Spayed/Neutered
Unaltered
Any health issues for dog two?
Yes
No
If yes, please explain for dog two:
Where was dog #2 obtained
Where does dog #2 sleep
Crate
Couch
Bed
Floor
Where is dog #2 kept when gone
Crate
Room
Loose in house
Outside
Dog #2 struggles with
Jumping
Pulling on a leash
Leash reactivity
Not coming when called
Counter surfing
Fearfulness
Attacking humans and/or dogs
Nipping
Anixety
House breaking
Destruction of property
Excessive barking of whinning
Riding in the car
Crating
Hyperactivity
Staying when asked
Any previous training for dog #2, if so please elaborate
Social Information for dog #2:
Good with other dogs
Good with other people
No bite history
Has dog issues
Has people issues
Has bitten a person
Has bitten a dog
Please elaborate for dog #2
Main goals to accomplish with dog #2
What kind of exercise and how much does your dog(s) get*
What equipment do you use on walks
Dog #1 Food Name*
Dog #1 Cups per feeding*
Do they finish their meal?*
Yes
No
Grazes
Dog #2 Food Name
Dog #2 Cups per feeding
Dog #2 Do they finish their meal?
Additional Notes