Paws & Reflect Dog Intake Form

Dog Intake Form for Boarding & Day Care
About You
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

Someone local who can be contacted and potentially collect a dog in an emergency
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Email*
example@example.com
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Dog
Dog's Name*
Dog’s Breed*
Colour / Markings*
Dog's Sex*

MaleFemale
Has your dog been neutered / spayed?*

YesNo
Dog’s Date of Birth*

DayMonthYear
Date
Microchip Number*
Vet & Insurance
Registered Vet*
Vet's Phone Number*
Please enter a valid phone number.
Insurance Details
Feeding
How many meals does your dog have each day?*
Meal 1 Time

Hour Minutes
Meal 1 Type
Meal 1 Amount
Meal 2 Time

Hour Minutes
Meal 2 Type
Meal 2 Amount
Meal 3 Time

Hour Minutes
Meal 3 Type
Meal 3 Amount
Meal 4 Time

Hour Minutes
Meal 4 Type
Meal 4 Amount
Additional Food / Meal Requirements or Instructions
Does your dog have any treats?*

YesNo
Treat Type
How many treats are allowed?
Can we provide high quality treats to reward good behaviour?

YesNo
Exercise
How many walks does your dog have a day?*
Walk 1 Time*

Hour Minutes
Walk 1 Duration*
Walk 2 Time*

Hour Minutes
Walk 2 Duration*
Walk 3 Time

Hour Minutes
Walk 3 Duration
Can your dog be walked off-lead?*

YesNo
Special Exercise Requirements or Restrictions
Vaccination Status

All dogs must be vaccinated against Distemper, Hepatitis, Parvovirus, Leptospirosis and Kennel Cough. Vaccinations must be completed at least 14 days before arrival
Please confirm that all vaccinations are up to date*

YesNo
Vaccination Records*

Cancelof
Flea, Tick & Worming Treatments

All dogs must be treated for fleas, ticks and worms at least five days before their stay
Flea Treatment Brand*
Flea Treatment Administered*

MonthDayYear
Date
Tick Treatment Brand*
Tick Treatment Administered*

MonthDayYear
Date
Worming Treatment Brand*
Worming Treatment Adminstered*

MonthDayYear
Date
Sleeping
What are your dog's sleeping arrangements?*
Please specify your dog's sleeping arrangements
Health
Known Allergies or Medical Conditions
Medications
Dietary Restrictions or Special Diets
Additional Health Notes
Behaviour
Is your dog house trained?*

YesNo
Has your dog ever bitten anyone?*

YesNo
Are there any behaviours that we need to know about? (e.g. may chase other dogs / walkers / deer; can be bouncy)
Additional Comments / Special Instructions
Please let us know about anything else that we might need to be aware of so that we can provide the best care for your dog
Data Protection & Privacy
Consent & Agreement
Paws & Reflect collects and stores the personal information provided on this form for the purpose of delivering dog care services safely and effectively, meeting our legal and licensing obligations, and contacting you about your dog’s care. All information is stored securely and will only be shared if required by law or to ensure your dog’s welfare (for example, with a veterinarian in an emergency).

You have the right to request access to, correction of, or deletion of your personal data at any time by contacting us at welcome@pawsandreflect.co.uk.
I consent to Paws & Reflect collecting, storing and using my personal data for the purposes described above*

Yes
Please review our Terms & Conditions
Consent and Agreement*

I authorise emergency medical treatment if neededI understand and accept the Terms & Conditions
Should be Empty:

Dog Intake Form for Boarding & Day Care

About You

Emergency Contact

Your Dog

Vet & Insurance

Feeding

Exercise

Vaccination Status

Flea, Tick & Worming Treatments

Sleeping

Health

Behaviour

Additional Comments / Special Instructions

Data Protection & Privacy

Consent & Agreement