Information Form
Please fill out the form below and I will contact you within 48 hours.
Client Information:
Client's Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Additional Phone Number
Please enter a valid phone number.
Pet Information:
Pet Name
*
Breed
*
For additional pets, please describe them below:
Age
*
Sex
*
Female
Male
Altered (Spay and Neutered)
*
Yes
No
Health and Behavior
Vet Clinic
*
Any current or previous medical conditions?
*
Is your pet on medication(s)?
*
Yes
No
List medication(s) here ( name, frequency and dosage)
Is your pet on Flea/ Tick Prevention and Heartworm Prevention?
If you have a dog(s), please continue to fill out the questions below.
How does your pet socialize with other dogs?
Is your dog possessive when it comes to toys or food?
Yes
No
If so, please elaborate on this behavior.
Is your dog crate trained?
Yes
No
Does your dog have separation anxiety? If so, in what situation?
Does your pet, or has your pet ever eaten an object(s) he/ she was not supposed to?
My dog barks...
Rarely or never
Sometimes, when I'm home
Sometimes, when I'm gone
Normally when left alone
Has your dog ever escaped, chewed through or otherwise damaged a crate while unattended?
Yes, damaged a crate
Yes, escaped
Never
Not crate trained
Does your dog get car sick?
Yes
No
Has your dog been boarded or been to day care previously? If so, how was their experience? Any concerns noted?
Is your dog E - Collared Trained?
Emergency Contact:
Name
*
First Name
Last Name
Relationship
Phone Number
*
Please enter a valid phone number.
What kind of services are you looking for? ( Boarding, Day Care, Drop - In's)
*
Dates for care if you have them
How did you hear about 406 Canine Club?
Signature
Date
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: