Blue Dingo - Walking Intake Form

Owner Name*
Date

MonthDayYear
Date
Phone #*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?
Dog's Name*
Dog's Date of Birth or Approximate*
Dog's Breed (or mix)*
Date of Adoption/Purchase*

MonthDayYear
Is your dog spayed/neutered or intact?*
Where did you acquire your dog? I.E., rescue, breeder, shelter, family friend,*
Any current medical issues?
Vaccination Expiration Dates:
Rabies exp date*

MonthDayYear
Kennel Cough exp date

MonthDayYear
Distemper/Parvo/ Lepto exp date

MonthDayYear
Second Dog's Name
Dog's Age
Dog's Breed (or mix)
Is your dog spayed/neutered or intact?
Where did you acquire your dog? I.E., rescue, breeder, shelter, family friend, etc.
Date of Adoption/Purchase

MonthDayYear
Date
Any current medical issues?
Vaccination expiration dates:
Rabies exp date*

MonthDayYear
Kennel Cough exp date

MonthDayYear
Distemper/Parvo/ Lepto exp date

MonthDayYear
Has your dog(s) received professional training?
If yes, where?
How does your dog feel about people entering your house?
Are you looking for a specific exercies ie walk, game of fetch, just a potty break?
What tools do you currently use to walk your dog, ie flat collar, harness, prong collar, electronic collar?
How does your dog behave on leash?
Is your dog comfortable having a collar put on and taken off?
Is your dog comfortable having a leash put on and taken off?
Is your dog comfortable being picked up, petted, or restrained?
Has your dog ever had bitten or snapped at a person? (Including groomer, vet staff, visitors to your home, etc.)
Is there anything else we should know about your dog?
Should be Empty: