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New Client Intake Form

Please fill in as much information as you can as it helps me keep track of important items related to your dog's care. This form assures that no detail will be missed.

I look forward to spending time with your pup!

First Name

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Last Name

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Email

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Phone Number

Please enter a phone number.

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How did you hear about us?

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Dog's Birthday

Dog's Age

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Dog's Breed

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Sex of Dog

Intact Male

Neutered Male

Intact Female

Spayed Female

What kind of food does your dog eat?

Kibble

Wet Food

Raw Food

Other

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Do they eat all at once or are they a grazer?

All at once

Grazer

Depends

Other

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Is your dog up to date on flea treatment and vaccinations?

Yes

No

Up to date on flea/tick but not vaccinations

Up to date on vaccinations but not flea/tick treatment

Unsure

Upload your vaccine records here:

Upload file

What commands/training does your pup know?

Sit

Stay

Lay down/down

Go to Bed/Place/Home

Down/Off

Shake

Recall (coming when called)

Door Manners

Other

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Would you consider your dog an escape artist?

no

yes

other

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Is your dog fully potty trained?

yes

no

other

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How Often Does Your Dog Require Potty Breaks?

Every Hour

Every 2 hours

Every 4 hours

Every 6 hours

Every 8 hours

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How long can your dog be left alone?

1 hour or less

2 - 4 hours

4 - 6 hours

6 - 8 hours

How many updates would you like during your pet's stay?

Every day

Every other day

Once a week

I don't want updates

What is your Dog's energy level?

High Energy

Moderate Energy

Low Energy

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What is the OWNER'S First and Last name your dog is registered under at their clinic?

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