Dog Care - Intake form

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Your Name* This field is required.
First Name
Last Name
2
Email
example@example.com
3
Phone Number
Area Code
Phone Number
4
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Invoice ID
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Your Dog's Name(s):* This field is required.
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Breed (if known):* This field is required.
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Approximate Date of birth* This field is required.
Month
Day
Year
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Sex:* This field is required.
Male
Female
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Spayed or Neutered:* This field is required.
Yes
No
No - my pet is too young
No - personal choice
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Approximate Weight:* This field is required.
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Where does your dog eat?: * This field is required.
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Does your dog eat dry food?* This field is required.
Yes
No
Other
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What time(s) of day is your dog fed their DRY FOOD. The times frames listed are my typical hours made available for feeding and may be adjusted according to your dog's visit schedule. Please check all that apply.* This field is required.We understand that your pet may eat earlier than 8:00am, however our pet care hours do not start until 8:00am each day. Please selct a time frame that is closest to your pet's current eating schedule.
Not applicable
6:00am to 10:00am
12:00pm to 1:00pm
6:00pm to 9:00pm
Other
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Name of dry food: * This field is required.Please be specific when completing. Especially if your pet is on a special diet. Sometimes we have to purchase food and we do not want to buy the wrong type!
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Location of where dry food is stored: * This field is required.
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Amount to feed dog EACH feeding:* This field is required.ex.1 cup
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Item used to measure food: * This field is required.ex. scoop in bag
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Does your dog eat wet food?* This field is required.
Yes
No
Other
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What time(s) of day is your dog fed their WET FOOD. The times frames listed are during our designated pet care hours and may be adjusted according to your dog's visit schedule. Please check all that apply.* This field is required.
Not applicable
6:00am to 10:00am
12:00pm to 4:00pm
6:00pm to 9:00pm
Other
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Brand of wet food: * This field is required.Please be specific when completing. Especially if your pet is on a special diet. Sometimes we have to purchase food and we do not want to buy the wrong type!
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Location where wet food is stored:* This field is required.
If this question does not apply to your pet please type N/A.
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Amount of wet food to feed per feeding:* This field is required.ex. 1/2 can
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Location of extra dry food and/or wet food: * This field is required.
If this question does not apply to your pet please type N/A.
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Location where food dishes are stored when not in use:* This field is required.
If this question does not apply to your pet please type N/A.
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Location of extra food dishes:* This field is required.
If this question does not apply to your pet please type N/A.
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Does the dog have a routine to follow before eating?* This field is required.
Yes
No
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Please descibe the routine in detail below.* This field is required.
29
Does your dog require any of the following when eating? Check all that apply.* This field is required.
Not Applicable
Feed apart from other pets
Supervise while eating
Remove food after so much time
Dispose of uneaten food
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Please specify how much time is needed before removing food* This field is required.
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Please give detailed instructions on how to feed your dog.* This field is required.
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Please speficy the type of water your provide for your dog.* This field is required.Water will be changed and refilled at each visit. Water bowls will be washed at least once per day.
Tap
Filtered from refridgerator dispenser
Filtered from pitcher in refridgerator
Filtered from sink
Bottled
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Location of water dish* This field is required.
Water dishes will be refilled at each visit and cleaned 1x per day.
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Is your dog restricted to a certain amount of water?* This field is required.
Yes
No
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Please inidicate how much water to provide at each refill* This field is required.
36
Special instructions for water* This field is required.
If this question does not apply to your pet please type N/A.
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Does your dog receive treats?* This field is required.
Yes
No
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Please indicate how many treats your dog can receive PER VISIT.* This field is required.
1/2 to 1 treat
1-2 treats
3-4 treats
No limit
Other
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Location where treats are stored* This field is required.
If this question does not apply to your pet please type N/A.
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When does your dog receive their treat?* This field is required.
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Does your dog have a special routine to follow before getting a treat?* This field is required.
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Does your dog require any of the following when receiving a treat?* This field is required.
Give treats apart from other pets
Supervise while eating treat
Remove treat after so much time
Dispose of uneaten treat
Not Applicable
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Special instructions for treats* This field is required.
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Does your dog receive medications? Include monthly preventative medications if they are required during my visit.* This field is required.
Yes
No
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Medication #1* This field is required.
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Location where Medication is stored* This field is required.
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Medication times* This field is required.
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Directions* This field is required.
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Additional Information* This field is required.
If this question does not apply to your pet please type N/A.
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If your pet has more than one medications please list the additional medications and instructions here.* This field is required.
51
Does your pet require a walk at our visit(s)?* This field is required.
Please walk my dog at least two times per day, otherwise please let my pet in the fenced yard.
Please walk my dog at least one time per day, otherwise please let my pet in the fenced yard.
Please only let my dog into the fenced yard. No walks are required.
My pet is an outdoor pet. No walks are necessary.
Other
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Where do you keep your pet's leash and/or collar?* This field is required.
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Please indicate if we need to avoid specific houses or areas while walking.* This field is required.
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Please indicate your pet's walking route.* This field is required.
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Location of pet waste bags* This field is required.
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Does your dog use potty pads?
Yes
No
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Location potty pad is kept for use
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Location of extra potty pads
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How often do you change out the soiled potty pads?Please note that Fuzzy Friends will not chnage out the cat litter unless requested by the client or if the reservation is greater than 2 weeks. An additional charge will apply.
Not Applicable
Once every other day
Once per day
Twice per day
Three times per day
Four times per day
Everytime the potty pad is soiled
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Where do you dispose of all pet waste?* This field is required.
61
Please let us know what games and or activities your dog likes to play and/or do.* This field is required.
Belly Rubs
Cuddle
Give kisses
Fetch
Tug-o-war
Chase
Walk
Run/Jog
Play with toys
My pet does NOT play games or activities
Other
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Does your pet play with toys?* This field is required.
Yes
No
63
Location of toys:
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Favorite Toys:
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Please list the commands and words your dog knows, should know, or ones that you would like them to know.* This field is required.
My pet does not know any commands or words
Sit
Stay
No
Come or Come Here
Outside or Go Outside
Go Poop
Go Potty or Go Pee
Do your business
Bad or Bad Dog/Cat
Go in the House
Down or Get Down
Off
Walk or Let's go for a walk
Food
Treat
Are you hungry?
Do you want to eat?
Who is here?
Who is at the door?
Good or Good Dog/Cat
Move or Move over
Ride or Do you want to go for a ride?
Lay Down
Don't Pull of No Pull
Cookie
Drop It
Slow Down
Heel
Walk Nice
Naughty
Don't Touch
Leave it
Other
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Is you pet crated or placed in a restricted area when no one is home?* This field is required.
Yes
No
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Please indicate your dog's living situation below. Please note that I will not take dogs outside off leash unless inside a secured fence - or unless you and I are both confident in your dog's recall with me during our intake meeting.* This field is required.
NOT allowed outdoors at all
Kept outside in fenced yard at all times when home
Kept outside in fenced yard only when they ask to go out
NOT allowed indoors at all
Allowed on furniture & beds
Not allowed on furniture & beds
Restrict dog area/crate ALL DAY & ALL NIGHT
Restrict dog area/crate when left alone
Restrict dog area/crate NIGHT ONLY
My pet is not restricted and can have access to the entire house at all times
Other
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Location of crate, gated off area, or fenced in yard* This field is required.
Please type N/A if this question does not apply.
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Please let us know which of the following your dog does NOT like.* This field is required.
Baths
Hot Days
Sharing Food Dishes
People or other pets near food dish
People or other pets near treats
Nail trims
Rain
Cold
Loud Noise
Vacuum
Thunder
Petting Hind End
Petting near the head
New or Strange Animals
Humans
Touching Ears
Touching Feet
Other family pets
Strangers
Fragrance Sprays
None of the above
Other
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Please let us know how your dog reacts to any of the above.* This field is required.
If this question does not apply to your pet please type N/A.
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Has your dog ever done any of the following?* This field is required.
Attacked and/or bit someone
Attacked and/or bit another animal
Escaped from home
Injured self out of boredom/fear
Not Applicable
72
Please describe the incident(s) even if mild or under extreme or unusual circumstances* This field is required.
If this question does not apply to your pet please type N/A.
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Where does your pet like to escape or hide?* This field is required.
Hides behind or under bed
Hides behind or under couch
Hides under tables
Hides in closets
Runs out doors
Runs upstairs
Not Applicable
Other
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Please indicate how your dog can be retrieved.* This field is required.
If this question does not apply to your pet please type N/A.
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Does your dog have any ongoing or reoccurring known illnesses and/or injuries? Is your dog undergoing any medical treatments?* This field is required.
Yes
No
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If yes please explain in detail.
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Did your dog have a previous illness or injury we should be aware of?* This field is required.
Yes
No
Unknown
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If yes please explain in detail.* This field is required.
79
Does your dog have allergies?* This field is required.
Yes
No
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If yes please list what type of allergies below.* This field is required.
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What type of symptoms does your dog exhibit when their allergies flare up?* This field is required.
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Please let us know what temperament and personality describes your dog. Check all that apply.* This field is required.
Calm
Sweet
Loving
Cuddly
Agressive
Hyper
Shy
Scared
Timid
Relaxed
Easy Going
Pushy
Suspicous
Aloof
Fearful
Lazy
Jealous
Trusting
Spiteful
Crazy
Other
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This form was prepared by:* This field is required.
First Name
Last Name
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Date* This field is required.
Date
Month
Day
Year
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1
2
3
4
5
6
7
8
9
10
11
12
Hour
30
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10
20
30
40
50
Minutes
AM
AM
PM
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Please use your mouse or finger to sign this document electronically.
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Signature of person preparing form:* This field is required.
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