Bad Dog Betty New Client Application Form
Please complete the following questions to the best of your knowledge.
Owner Info
Your Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
What is the best way to contact you?
*
Please Select
Phone Call
Text Message
Email
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Second Owners name (If Applicable)
First Name
Last Name
Relationship to you
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Children in the household/ Ages?
*
Emergency Contact
*
First Name
Last Name
Emergency contact Phone Number
*
-
Area Code
Phone Number
Dog Info
Dog's Name
*
First Name
Last Name
Dog's Age
*
Ex: 2 years
Sex
*
Please Select
Female
Male
Spayed/Neutered
*
Please Select
Yes
No
Food Allergies
*
Breed/Mix?
*
Where does your pet come from? Breeder, shelter, etc?
*
Length of ownership?
*
Ex: 3 months
Behavioral issues?
Bite History? Please give details
*
Friendly with Children?
*
Please Select
Yes
No
Some, not all
Friendly with other dogs?
*
Previous Training? How did it go?
*
What are you looking to accomplish with training? (if applicable)
Has your dog ever been boarded at either a kennel, vet, or private household?
*
Please list any health issues or injuries for your dog(s). Please include Medications.
Second Dog
Skip if not applicable
Dog's Name (second)
First Name
Last Name
Dog's Age
Ex: 2 years
Sex
Please Select
Female
Male
Spayed/Neutered
Please Select
Yes
No
Food Allergies
Pet's breed? Mix?
Where does your pet come from? Breeder, shelter, etc?
Length of ownership?
Ex: 3 months
Bite History
Behavioral issues?
Friendly with other dogs?
Previous Training? How did it go?
What are you looking to accomplish with training?(second dog if applicable)
Has your dog ever been boarded at either a kennel, vet, or private household?
Please list any health issues or injuries for your dog(s). Please include Medications.
Additional Info
What service are you interested in?
*
Please Select
Board & Train
Puppy Consult
Behavioral modification
Boarding
Enrichment/Training outing
I'm unsure/multiple
Would you like to add a picture of your dog(s)? Not required but always welcome!
Browse Files
Cancel
of
Any additional info you would like to add?
How did you hear about Bad Dog Betty?
*
Vet Info
Vet Clinic Name
*
Vet Name
*
First Name
Last Name
Clinic Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Vaccination Records (Dog 1)
*
Browse Files
Cancel
of
Vaccination Records (Dog 2)
Browse Files
Cancel
of
Please verify that you are human
*
Save
Submit
Should be Empty: