CK9DS Application for Additional Dogs PDF

Instructions:

1. New clients - this form is for additional dogs. If you are a first time client with multiple dogs please ensure you have filled out the orginal application first with your service request and personal information, 1st dog's information and contract policy and release signatures.

2. Existing clients that have an new dog or changes need to be made for an existing dog can use this form as well. You can update any changes needed regarding general information, feeding, medical conditions, medications or behavioral. Just update the sections that apply.

3. Send current proof of current vaccination records from Veterinarian. Summary page of when vaccines due is fine.

4. Any additional dogs you will have an opportunity on the Thank You Page to fill this form out again for another dog.

Owner's Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Veterinary Clinic Name*

Doctor's Name

Clinic Phone *

Vet Office

Clinic Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Important: A copy of your dog's shot records will need to be sent to us 5 days prior to the first check in of your dog. Please make sure you confirm we received records prior to bringing your dog. Current shots consist of rabies, distemper, parvo etc (DHLPP), and Kennel cough recommended. All vaccines should be current at least 5 days prior to your pets visit. Absolutely no exceptions. We have the right to refuse accommodation if requirements are not met.

Dog's Name*

Breed*

Okay to put mix breed if not sure

Birth Date*

Date

Age

Weight Lbs.

Sex:*

MaleFemale

Spayed / Neutered:*

YesNo

Is your dog housebroken?*

YesNo

Is your dog crate trained?*

YesNo

Is your dog mostly in

The HouseOutsideBoth

Where does your dog stay when you leave the house?

What brand of dog food do you feed?*

How much food per meal?*

Ex. 1 cup or 1/2 cup or 1/2 can or 1/3 package

Feeding Schedule (check all that apply)?*

AMNoonPMFree Feed

Please list any special feeding instructions (like special bowls/raw food feeding. refrigeration/freezer. severe food allergies, etc.)

0/330

List Vaccine Due Dates:

Rabies

Date

DHPP/DHLPP/DA2PP

Date

Kennel Cough

Date

Lepto

Date

Is your dog current on Heartworm Preventative?

YesNo

Is your dog on Flea Control?

YesNo

Does your dog have any medical / mobility problems?

YesNo

If yes, explain medical/mobility issues:

0/215

Does your dog require medications/supplements?

YesNo

Please list medications/supplements and purpose and administer times required of meds/supplements:

0/330

Companion K-9 Dog Services

Owner's Personal Information:

Veterinary Information:

Pet Information:

Pet Feeding Information:

Pet Vaccination and Medication/Supplement Information:

Pet Other Information: