NEW CLIENT ENROLLMENT FORM
HUMAN INFORMATION
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Format: (000) 000-0000.
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Pet Information
Dog's Name
*
Breed
*
Description (color/markings)
*
Age
*
Sex
*
Spayed/Neutered?
*
Yes
No
Microchip/Tattoo
*
Where did you get your dog?
*
How long have you had your dog?
*
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What is your dog's general temperament?
*
Does your dog have any fears/dislikes?
*
What cues does your dog know?
*
Example: sit, stay, come
What is your dog’s energy level?
*
High
Medium-High
Medium-Low
Low
Does your dog play/get along with other dogs regularly?
*
Has your dog ever been in a fight? If so what were the circumstances?
*
Has your dog ever bitten another dog or person? If so what were the circumstances?
*
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WALKING INFORMATION
What does your dog walk with?
*
Example: harness, halti, martingale
How is your dog on-leash?
*
Example : leash reactive, pulls, picks up garbage
Has your dog ever been to a dog park?
*
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HEALTH INFORMATION
How would you describe your dog's general health?
*
Does your dog have any illness/allergies?
*
Is your dog on flea/tick medication?
*
Veterinary Hospital Name and Telephone #
*
Is your dog up to date on all of their vaccines? Please upload your dog’s current vaccine history below prior to their visit.
*
Rabies
DHPP
Bordetella
Parvovirus
Lepto
Influenza
Medical Record Upload
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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I would like to opt into text and/or email communications and promotions from Kare by Q. I am aware that I can opt out at anytime.
*
Please Select
Text only
Email only
Surprise me!
My dog can be featured on Kare by Q’s social channels
*
Please Select
Yes
No
CLIENT AGREEMENT
Signature
*
Submit
Submit
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