Paw Care Application

Paw Care Application
122 Linsley Ave., Brandon, FL 33511

813.800.DOGG (3644)
Owner's Last Name*
Owner's First Name*
Pet Name:*
Breed:
DOB:
Weight:
Spayed/neutered?

YesNo
Base Color:
Purpose of Eval:

BoardingDaycareBoth
Client Information
Address:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Rent or own or other?
Driver License No & State*
Phone/Mobile:*
(provide best number to get in touch with you)
Work phone (not cell):
Employer Name & Location*
Co Owner's Full Name:
If Address is different:
Other person authorized besides listed above to pick up pet while in our care?
(name, relationship & phone please)
EMERGENCY CONTACT INFORMATION

If you are unable to be reached, the information below will be used as an emergency contacts (Below individuals should have the ability and permission to make both financial and emergency decisions for you and your pet. Needs to be someone else that doesn't travel with you or spouse.
Name & Phone:*
Name & Phone:
Veterinarian Name & Clinic*
Vet Phone #
PET HEALTH

(Select all appropriate answers)
Allergies (including food)

YesNo
If yes, please note allergies:
Medical Condition

YesNo
Medications

YesNo
If, yes, name of medication, amount and frequency
SOCIAL BACKGROUND
Does your dog live with other dogs?

YesNo
Is your dog a rescue?

YesNo
If your dog is a rescue, how long has dog been in your home?
Does your dog go to dog parks?

YesNo
Does your dog do well with other dogs?

YesNo
Your dog interacts best with:

Smaller dogsDogs same sizeBigger dogsIndividual play
Has your pet been boarded?

YesNo
Has your dog gone to daycare?

YesNo
Please provide Name & Number of previous facility for daycare and/or boarding:
BEHAVIORAL
Was your dog crate trained?

YesNo
Describe your dog's behavior during thunderstorms (calm, nervous, scared, no reaction):
Has your dog ever dug or jumped a fence?

YesNo
Has your dog shown signs of food aggression?

YesNo
Has your pet ever been in a fight?

YesNo
Has your dog ever bitten another dog?

YesNo
If yes, to fight or bitten, please expand on situation.
Has your pet ever bitten another human?*

YesNo
Does your pet have accidents in the crate or house?

YesNo
Does your pet exhibit any anxiety while alone? (destructive behavior, barking, etc)

YesNo
Does your pet have any other fears or anxieties?

YesNo
If yes, please explain:
Has your pet been off leash outdoors?

YesNo
Does your pet exhibit any of the following guarding actions?

With ToysWaterPeopleOther
FEEDING INSTRUCTIONS
Do you give your pet treats?

YesNo
May we give your pet treats?

YesNo
May we use wet food?

YesNo
Type of food:

WetDry
Amount
Times per day
Brand of food
If your pet becomes stressed/excited in boarding and is not eating, can we use wet food or broth to entice?

YesNo
Additional feeding instructions:
NOTE: Please do not bring large bags of food. Food must be in individual bags per feeding and labeled with your pet's first and last name.
How did you hear about The Dog Patch?*

FB/IGGoogleWord of MouthOther
By signing below, I agree with the requirements listed on this application. I certify the information provided is accurate, true and complete.
Signature:*

Clear
Name:*
Date:*

MonthDayYear
Date
The Dog Patch, 122 Linsley Ave., Brandon, FL 33511

Phone: 813.800.DOGG (3644)
Should be Empty:

Paw Care Application

122 Linsley Ave., Brandon, FL 33511

Client Information

EMERGENCY CONTACT INFORMATION

PET HEALTH

SOCIAL BACKGROUND

BEHAVIORAL

FEEDING INSTRUCTIONS

By signing below, I agree with the requirements listed on this application. I certify the information provided is accurate, true and complete.