Dog Intake Form

Dog Intake Form

Help Us Get to Know Your Dog!
Owner Name*
Email Address*
Phone number*
2nd Owner Name
Email Address
Phone number
Home Address*
Pet Name*
Breed*
Weight*
Age*
Sex*
Pet Name
Breed
Weight
Age
Sex
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Pet Name
Breed
Weight
Age
Sex
DAILY ROUTINE

(if applicable)
Feeding Time(s)
Amount of Food
Food Sensitivities
Food/Treats Location*
Walk time(s)
Yard Time(s)
Location of Bag Disposal?*
Where are Extra Poop Bags?*
Collar/Harness/Leash Locations?*
Likes to be Brushed?*
Where is the Brush?*
Hiding Spots?*
Medications?*
Name & Dosage*
When are Meds Administered?*
How are Meds Administered?*
Special notes?
VETERINARIAN INFORMATION
Name*
Phone Number*
Address*
EMERGENCY CONTACTS

Owners cannot be listed as emergency contacts
Name*
Phone Number*
Name*
Phone Number*
MISCELLANEOUS INFORMATION
Location of Cleaning Supplies*
Location of Towels for When it Rains*
Location of Extra Garbage Bags*
Location of Extra Paper Towels*
Thunder Sensitive?*
What are some coping strategies?*
Door Keycode*
Home Security Code
Is there a landscaper, house cleaner, etc. the Company should be aware of?*
Day(s)/time(s) they visit*
Are there cameras in your home or on the property?*

YesNo
Where are they located?*
Escape Artist(s)?*
Vaccinations Up-to-Date?*
Does your dog(s) have a bite history?*

YesNo
Please explain.*
Is your dog(s) reactive towards other animals (dogs, cats, squirrels, rabbits, etc.)?*

YesNo
Please explain.*
Does your dog(s) have a history of illness?*

YesNo
Please explain, and is any illness a current concern?*
Can the company use pictures/videos of your pet(s) in its social media?*

YesNo
What is your Instagram handle/name so we can tag you in posts about your pet?
How did you hear about Michelle's Pet Care?*
Anything else the Company should know/Additional comments:
Should be Empty:

Dog Intake Form

DAILY ROUTINE

VETERINARIAN INFORMATION

EMERGENCY CONTACTS

MISCELLANEOUS INFORMATION