Parker's Dog Training New Dog Intake Form

Dog Info Sheet
- Owner’s Name*
  
  First NameLast Name
- Owner’s Email*
  example@example.com
- Owner’s Home Address (where the dog primarily resides)*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Owner’s Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Alternate/Emergency Contact Name*
  
  First NameLast Name
- Emergency Contact Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Dog’s Regular Veterinarian *
- Dog’s Regular Veterinarian Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Dog’s Regular Veterinarian Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Dog’s Name*
- Dog’s Breed *
- Dog’s Sex*
  
  MaleFemale
- Is the dog sterilized (neutered or spayed)*
  
  NoYes
- Dog’s Date of Birth*
  
  MonthDayYear
  Date
- Date of Dog’s Last Fecal Float*
  
  MonthDayYear
  Date
- Result and Treatment (if any)*
  Ex.: Negative, or Positive for Hookworms, treated with Panacure
- Dog is Up To Date on Vaccinations*
  
  YesNo
- Please Explain*
  Ex.: Dog is too young
- Dog’s Food*
  Be Specific. Example: Natural Balance, lamb, puppy, small bites
- Amount of Food per Meal*
  In Cups
- Meals per day*
- Supplements or Medications*
- Additional Feeding Notes*
- Is your dog a finicky eater?*
  
  YesNo
- If “Yes” please be specific:*
- Does your dog have a sensitive stomach?*
  
  YesNo
- If “Yes” please be specific:*
- Does your dog have allergies or any medical conditions?*
  
  YesNo
- If “Yes” please be specific:*
- Is your dog crate trained?*
  
  YesNo
- If”Yes” please be specific on when and how, if “No” please state why:*
- Does your dog chew or ingest bedding?*
  
  ChewsIngestsNo
- If “Yes” please be specific:*
- Does your dog chew or ingest toys?*
  
  ChewsIngestsNo
- If “Yes” please be specific:*
- Has your dog ever shown signs of aggression towards dogs? (Barking, lunging, growling, biting etc.)*
  
  YesNo
- Please explain in detail and if a bite occurred, anyone was anyone injured, broken skin etc.*
- Has your dog ever shown signs of aggression towards humans? (Barking, lunging, growling, biting etc.)*
  
  YesNo
- Please explain in detail and if a bite occurred, anyone was anyone injured, broken skin etc.*
- Should be Empty:

Dog Info Sheet