New Client Registration Form
How did you hear about us?
*
Please Select
Google
Social Media
Word of Mouth
The Vet
How many pets do you have?
1
2
3
4
Paw-rent Information:
Primary Guardian Full Name
*
First Name
Last Name
Primary Guardian Phone Number
*
Primary Guardian E-mail
*
example@example.com
Secondary Guardian Full Name
First Name
Last Name
Secondary Guardian Phone Number
Secondary Guardian E-mail
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Back
Next
Pet Information:
Pet Name
*
First Name
Breed
*
Which describes your pet?
*
In-tact Female
In-tact Male
Spayed Female
Neutered Male
Date of Birth or Best Guess
*
/
Month
/
Day
Year
Veterinarian
*
Veterinarian's Phone Number
*
Vaccine Certificate
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Any current medication or medical issues?
*
Check any behavioral issues your pet is struggling with...Don't worry, he's still a good boy! :-)
Food aggression
Seperation anxiety
Jumping
Leash reactivity
Resource guarding
Excessive vocalizing
Eating things he shouldn't
Destructive tendencies
Innapropriate elimination
"Counter surfing" (stealing things off of the counter)
Reactive towards people
Reactive towards children
Reactive towards dogs
Reactive towards cats
Biting
Other
Has you pet ever bit a person? If yes, please explain in detail.
*
Which best describes your pet with new people?
*
Please Select
Loves new people
Neutral around new people
Nervous around new people
If your pet is a dog, which best describes your pet with other dogs?
Please Select
Loves other dogs
Neutral around dogs
Reactive around dogs
Please share some of your pet's hobbies and or favorite things:
*
Back
Next
2nd Pet Information:
Pet Name
*
First Name
Breed
*
Which describes your pet?
*
In-tact Female
In-tact Male
Spayed Female
Neutered Male
Date of Birth or Best Guess
*
/
Month
/
Day
Year
Veterinarian
Veterinarian's Phone Number
Vaccine Certificate
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Any current medication or medical issues?
*
Check any behavioral issues your pet is struggling with...Don't worry, he's still a good boy! :-)
Food aggression
Seperation anxiety
Jumping
Leash reactivity
Resource guarding
Excessive vocalizing
Eating things he shouldn't
Destructive tendencies
Innapropriate elimination
"Counter surfing" (stealing things off of the counter)
Reactive towards people
Reactive towards children
Reactive towards dogs
Reactive towards cats
Biting
Other
Has you pet ever bit a person? If yes, please explain in detail.
*
Which best describes your pet with new people?
*
Please Select
Loves new people
Neutral around new people
Nervous around new people
If your pet is a dog, which best describes your pet with other dogs?
Please Select
Loves other dogs
Neutral around dogs
Reactive around dogs
Please share some of your pet's hobbies and or favorite things:
*
Back
Next
3rd Pet Information:
Pet Name
*
First Name
Breed
*
Which describes your pet?
*
In-tact Female
In-tact Male
Spayed Female
Neutered Male
Date of Birth or Best Guess
*
/
Month
/
Day
Year
Veterinarian
Veterinarian's Phone Number
Vaccine Certificate
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Any current medication or medical issues?
*
Check any behavioral issues your pet is struggling with...Don't worry, he's still a good boy! :-)
Food aggression
Seperation anxiety
Jumping
Leash reactivity
Resource guarding
Excessive vocalizing
Eating things he shouldn't
Destructive tendencies
Innapropriate elimination
"Counter surfing" (stealing things off of the counter)
Reactive towards people
Reactive towards children
Reactive towards dogs
Reactive towards cats
Biting
Other
Has you pet ever bit a person? If yes, please explain in detail.
*
Which best describes your pet with new people?
*
Please Select
Loves new people
Neutral around new people
Nervous around new people
If your pet is a dog, which best describes your pet with other dogs?
Please Select
Loves other dogs
Neutral around dogs
Reactive around dogs
Please share some of your pet's hobbies and or favorite things:
*
Back
Next
4th Pet Information:
Pet Name
*
First Name
Breed
*
Which describes your pet?
*
In-tact Female
In-tact Male
Spayed Female
Neutered Male
Date of Birth or Best Guess
*
/
Month
/
Day
Year
Veterinarian
Veterinarian's Phone Number
Vaccine Certificate
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Any current medication or medical issues?
*
Check any behavioral issues your pet is struggling with...Don't worry, he's still a good boy! :-)
Food aggression
Seperation anxiety
Jumping
Leash reactivity
Resource guarding
Excessive vocalizing
Eating things he shouldn't
Destructive tendencies
Innapropriate elimination
"Counter surfing" (stealing things off of the counter)
Reactive towards people
Reactive towards children
Reactive towards dogs
Reactive towards cats
Biting
Other
Has you pet ever bit a person? If yes, please explain in detail.
*
Which best describes your pet with new people?
*
Please Select
Loves new people
Neutral around new people
Nervous around new people
If your pet is a dog, which best describes your pet with other dogs?
Please Select
Loves other dogs
Neutral around dogs
Reactive around dogs
Please share some of your pet's hobbies and or favorite things:
*
Back
Next
Can your pet(s) be posted on our social media?
*
Yes, please
No, thank you
Lability
*
By checking this box, I am agreeing to liability of my pet's behavior. If my pet harms anyone while working with Paws-itively Lucky, I am personally and financially responsible for the damages.
Signature
Submit
Submit
Should be Empty: