Client Information Form
Filling out this form will help us get to know you and your dog in preparation for our time together! Information shared in this file will stay confidential and will only be used to benefit the well-being of your dog during their stay with us.
Pet Information
Dog's Full Name
First Name
Last Name
Current age of your dog at the time of this form. Form must be updated yearly and as new information arises.
Dog Birth Date
-
Month
-
Day
Year
Date
Dog Gender
Please Select
Female
Male
Dog Weight
Dog Breed
Detailed description of your dog. Color, markings, spots... (in the case of an emergency, we'd like a full detailed description)
Please upload a recent photo of your dog
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Is your dog microchipped?
Please Select
Yes
No
Is your dog netuered/spayed?
Yes
No
Dog Behavior
If your dog has any anxiety, we do need to be aware of it. Please share details of what their anxiety looks like, sounds like, and/or in what scenario does it appear? What strategies do you use to help guide them through their anxiety? Do they take meds to help? (excessive barking, whining, panting, etc....) We work to provide all our dog guests a stress-free environment during their stay. Your dogs' stress level will affect the rest of the pack. If you plan to board your dog, please prep ahead of time to give your dog the best possible chance to be successful for a long stay without you. If your dogs' level of anxiety is not manageable, we will not have the capacity to care for them.
Separation Anxiety. Currently, to your knowledge what is the level of your dog's separation anxiety (when you/your dog's immediate family are not present or when they are in a new space)? Signs of separation anxiety may be one, few or all of the listed: Anxious behaviors like pacing, whining, trembling, excessive barking, or howling. Or they may be destructive; chewing, digging, or having accidents in the house, etc..
Non-existent
1
2
3
4
Very High
5
1 is Non-existent, 5 is Very High
What is your dog's anxiety level in a kennel?
Low
1
2
3
4
High
5
1 is Low, 5 is High
What is your dog's anxiety level with barriers and/or boundries?
Low
1
2
3
4
High
5
1 is Low, 5 is High
What level of redirection does your dog need? If/when your dog needs to be redirected to make another choice or to stop what they are doing, do they listen?
Very Minimal
1
2
3
4
A lot
5
1 is Very Minimal, 5 is A lot
What strategies/specific phrases do you use to help redirect your dog?
What tools (if any) do you use to help train/manage/help your dog? These tools will need to be present and provided (by you) during your dogs' stay.
What is your dog's level of recall? Does your dog return to you when their name is called when?
Non-existent
1
2
3
4
Excellent
5
1 is Non-existent, 5 is Excellent
What is your dog's energy level in a social setting? ...in a new environment, when a new dog is present, etc...
Low
1
2
3
4
High
5
1 is Low, 5 is High
What is your dog's energy level when playing with other dogs?
Low
1
2
3
4
High
5
1 is Low, 5 is High
What is your dog's overall energy level at home in their "normal home setting"?
Low
1
2
3
4
High
5
1 is Low, 5 is High
Is your dog house trained?
Please Select
Yes
No
If your dog still has/is having accidents in the home, please be transparent with us. Is your dog used to going potty indoors vs outdoors? If it's due to age, or other medical concerns, please inform us. You (the owner) must provide belly bands/dog diapers and/padding --we are more than happy to change them and lay out pads for them during their stay. Share details below if applicable.
Does your dog mark? No problem. If they mark, please plan ahead. You (the owner) must provide belly bands/dog diapers and/padding --we are more than happy to change them as needed. Share details below if applicable. *BOARDING: Please note that though your dog MAY not mark in your home, our home is new territory with many dog smells and they MAY mark. In the case that they do mark in our home, we will introduce your dog to an appropriate "diaper" wear until they show signs of not marking indoors. You will be notified in this case. If your dog needs to wear a diaper but refuses, we are not able to care for them in our home.
Does your dog get along with children?
Please Select
Yes
No
Does your dog get along with other dogs?
Please Select
YES
NO
How does your dog react to puppies (under age 1 year of age)?
How does your dog react to senior dogs?
How does your dog react to dogs smaller and/or bigger than they are in size?
What is your dogs' play style when playing on their own or with you?
What is your dogs' play style with other dogs? ..with family dogs, other dog friends, and/or unfamiliar dogs?
How does your dog react to a (human) stranger entering your home/yard/space?
How does your dog react to another dog (stranger dog) approaching or passing by? If your dog is reactive, please share strategies you've used to redirect/help your dog. We will do what we can to help reaffirm your training methods with your dog.
Has your dog growled and/or snarled at someone or at another dog? If yes, what was the circumstance?
Does your dog have reliable recall off-leash? What phrases? What gestures? Do they have a nickname? *Example: no leash or tie-out while within a fenced yard. If their name is called, can we rely on their recall skills to respond and redirect? *we do not provide field trips to off-leash dog parks.
Is your dog reactive? (...while on/off leash? Do they bark and/or become uncontrollable at the sight and sound of certain things). Please explain.
Is your dog aggressive or can become aggressive? (territorial, resource guarding, prey drive, guarding behavior...) Please explain. Share strategies you've used with your dog.
Has your dog ever bitten a person and/or another dog/pet? If yes, what was/were the circumstance/s?
Is your dog crate/kennel/x-pen trained? Do they feel safe, comfortable and calm inside a barrier without anxiety and/or excessive barking and/or attempting to escape?
Please Select
YES
NO
What has been your dogs' experience in a kennel/crate/x-pen? *Your dog must be comfortable being in a kennel/crate/x-pen and/or behind a gate and not show any signs of boundary frustration or anxiety.
Has your dog climbed/jumped/scaled/escaped a fenced/gated area? If yes, how high and what was the circumstance? BOARDING: Our fenced in dog run is only about 4 feet high in height and we do not have the capacity to provide care for dogs who are and/or may become a risk as an escape artist. You know your dog best, if free roaming in a fenced-in backyard should not be an option ever while on our property or yours, you need to let us know.
Has your dog received drop-in care services (where a dog sitter comes into your home to care for your dog) before? If so, describe their experience from what you know.
Has your dog been in daycare/boarding (where your dog is provided care outside of your home) before? If so, describe their experience from what you know.
Does your dog Resource Guard? Do they snarl or growl with toys, food, people, etc? If yes, please share the circumstances below.
Has your dog shown signs of/or is dominant with other dogs? If yes, what was/were/is the circumstance/s?
Are there any other behaviors that we should be aware of?
Describe what your dog's home life looks like? Are there many people at home? Adults and Children? Is it a busy household vs a more calm environment.
Please share your dog's (most normal) daily routine:
Meal
Owner/s must provide their own dog food. We ask for details in the case of an emergency. Example --Delayed flights, or unplanned extended stay. BOARDING: Each meal should be individually packaged into baggies and labeled with your dog’s full name. Large containers/bags of dog food should only be provided for dog’s staying for a longer period of time.
Type of Food
Brand of Dry kibble, toppers, canned, raw, etc...
Feeding Instructions
How much? How many times per day? ...use a slow feeder, warmed up, cold, room temp, etc...
Does your dog have any food allergies? Please explain.
Is your dog allowed to be offered treats (not from home)? We provide treat brands/products carried at Sam's Club, Costco, Target, Chuck & Don's and Pet Evolution. *BOARDING/DAYCARE: You may provide your own treats from home, please be sure to label.
Please Select
YES
NO
What, if any fruits/veggies is your dog allowed to consume as a treat? If none, state NONE
In the case of special events/celebrations, is your dog allowed to participate in consuming commercial bought treats? ex. Dog friendly cupcake birthday treat, purchased from Nadia's
Health Information
Veterinarian Name
First Name
Last Name
Veterinary Hospital Name
Veterinary Hospital Number
Please enter a valid phone number.
Your dog must be updated on all their vaccinations. Minimum requirement: Rabies, Distemper, Parvo and Bordetella. Upload your dogs' vaccination records
*
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If you have more records to upload, please do so here
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Is your dog on flea and/or tick treatment?
Please Select
YES
NO
I understand that my dog must be on a flea and/or tick treatment.
Please Select
YES
Is your dog spayed/neutered? *BOARDING/DAYCARE: We DO NOT provide service for female dog's in heat. In the case that your dog begins their heat cycle while in our care, you will be contacted for immediate pick-up. If we cannot reach you, names on your emergency list will be contacted for immediate pick-up.
Please Select
YES
NO
Does your dog have any medical conditions? If yes, please explain.
Is your dog on any medication? If yes, please explain condition, dosages, what/when/how medication needs to be administered.
Does your dog have any medical allergies? Please explain.
**Sensitive SENIOR DOG Question -- If you have a senior dog, what is your proposed end of life care plan in the case that they are in the sitter's care?
Pet Owner Information
Name
First Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.
Emergency Contact Information
Emergency Contact Person
First Name
Last Name
Relation to your Emergency Contact Person
Emergency Contact Persons' Cell Number
Please enter a valid phone number.
Name of Emergency Person with permission to pick up my dog
First Name
Last Name
Name of Emergency Person with permission to pick up my dog
First Name
Last Name
Name of Emergency Person with permission to pick up my dog
First Name
Last Name
Name of Emergency Person with permission to pick up my dog
First Name
Last Name
Any Additional Comments
Photo Updates
We will keep you updated with boomerang videos and/or photos throughout their stay.
*Photo and Video Release: by booking with us and/or asking to receive photos from your pets' stay with us, you (the pet owner) agree to allow us to use images that we take of your pet and their image or likeness in any form, for use at any time, in any media, marketing, advertising, illustration, trade or promotional materials without compensation, and release all rights that you may possess or claim to such image, likeness, recording etc. Example: placement on our social media page/s and website.
Yes, I would like to receive photo/video updates during their stay
No, thank you. I understand that I will not receive any photo/video updates during their stay
Social Media
Please share your account names/handles ONLY if you'd like to be tagged, notified, or DM'd on social media and/or if this can be used as a main contact in the case of an emergency.
Your FaceBook
Your Instagram
Pet Facebook
Pet Instagram
Other
Payment Information
Venmo Handle
Venmo QR Code
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Paypal Email
Paypal QR Code
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