Client Form
Contact Information
Name
*
First Name
Last Name
Email
*
Phone Number
*
Address
*
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
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Dog Information
Name
*
Age
*
Breed
*
Description
*
Sex
*
Please Select
Male
Female
Neutered / Spayed
*
Please Select
Yes
No
Microchip Number
*
Pet Insurance Provider
*
Pet Insurance Policy Number
*
Date of Last Flea Treatment
*
-
Day
-
Month
Year
Date
Date of Last Worm Treatment
*
-
Day
-
Month
Year
Date
Date of Last Vaccinations
*
-
Day
-
Month
Year
Date
Date of Kennel Cough Vaccination
*
-
Day
-
Month
Year
Date
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Dog Behaviour
Has your dog ever shown fear or aggression towards adults?
*
Please Select
Yes
No
Has your dog ever shown fear or aggression towards children?
*
Please Select
Yes
No
Has your dog ever shown fear or aggression towards other dogs?
*
Please Select
Yes
No
If you answered yes to any of the above, please give details
Does your dog ever attempt to dart through an open door
*
Please Select
Yes
No
Does your dog chase cats / squirrels / foxes?
*
Please Select
Yes
No
Does your dog chase livestock (sheep / horses / other)?
*
Please Select
Yes
No
Has your dog ever jumped/climbed a fence or wall?
*
Please Select
Yes
No
Can your dog be let off-lead for walks?
*
Please Select
Yes
No
How reliable is your dog's recall?
*
Not reliable
1
2
3
4
Perfect every time
5
1 is Not reliable, 5 is Perfect every time
Does your dog wear a harness?
*
Please Select
Yes
No
Has your dog ever slipped their collar and/or harness and run off?
*
Please Select
Yes
No
How often does your dog get exercised?
*
Duration of exercise?
*
What form of exercise does your dog get?
*
Where does your dog's exercise take place?
*
What is your dog's swim strength?
*
Poor swimmer
1
2
3
4
Strong swimmer
5
1 is Poor swimmer, 5 is Strong swimmer
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Health
Is your dog physically healthy, according to your veterinarian?
*
Please Select
Yes
No
Please advise any ongoing issues
Please advise any medications your dog requires
Please advise any changes in behaviour due to any medications
Please describe your dog's usual emotional state
*
Does your dog suffer with travel sickness
*
Please Select
Yes
No
History
How long have you had your dog?
*
Has your dog received any training
*
What training/equipment was used (if any)
Treats
Does your dog have any known allergies?
*
Do you consent to your dog having the following treats?
Vegetable bites (carrot/pepper/sweet potato)
Cheese
Sausage/hot dog
Dry kibble/bought treats
Homemade treats (fish, almond flour, eggs)
Sprats
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For Boarding Only
What brand and type of food is your dog currently fed?
How many meals per day does your dog have, and at what time(s)?
Where does your dog normally sleep at night?
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Any Other Information
Please advise any other information or considerations you would like to advise
Declarations
Please advise how you heard about P.A.W.
Photography & video - I am happy for images and videos of my dog to be used on P.A.W. social media and website
*
Please Select
Yes
No
Off-lead Permissions - I am happy for P.A.W. to walk my dog off-lead
*
Please Select
Yes
No
To the best of my knowledge, all of the details I have provided within this form are true and correct
*
Confirm
Signature
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