Island Dogs Canine Service- New Client Form
*All information disclosed is private and confidential.*
Owner(s) Information
First Name:
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Last Name:
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Phone Number:
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Email:
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Home Address:
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First Name (Secondary):
Last Name (Secondary):
Phone Number (Secondary):
Email (Secondary):
Pet(s) Information
Name(s):
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Age(s):
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Weight(s):
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Breed(s):
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Sex(es):
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Color/Markings:
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Spayed/Neutered:
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Microchip Number:
Health
Does your dog have any preexisting conditions? (e.g. arthritis, hip dysplasia, seizures, diabetes, autoimmune, etc):
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Does your dog take any medications for conditions? (Please list all that apply):
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Does your dog have any food allergies or sensitivities? (Please list all that apply):
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Behavioral Information
Does your dog have any history of aggression/reactivity? (People, dogs, food, toys, barriers, etc):
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Is your dog comfortable around other dogs?:
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Is your dog comfortable around other people/strangers?:
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Is your dog comfortable around children?:
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Any known triggers? If yes, please state explicitly. (Ex. loud noises, bikes, trucks, fireworks, men, etc):
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If your dog does have triggers, please explain how the behaviors display. (Ex. Barking, growling, lunging, whining, retreating, etc):
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Does your dog have separation anxiety?:
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Any known bite history? (If yes, please explain):
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Any pulling or leash reactivity?:
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Any specific commands or training your dog follows? If yes, please explain:
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Care Instructions
Food Type/Brand:
Amount per Feeding:
Feeding Schedule:
Medications & Dosage:
Special Care Notes:
Service Details
Requested Services (Check all that apply):
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Walking
Overnight In-Home Sitting
Other
Frequency of Service:
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Daily
Weekly
As Needed
Home Access Instructions:
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Walking Equipment (Collar, Harness, Leash Type, etc.)
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Veterinarian Information
Clinic Name:
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Clinic Address:
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Clinic Phone Number:
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Doctor's Name:
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Emergency Contact
First Name:
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Last Name:
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Relationship to Owner:
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Phone Number:
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First Name:
Last Name:
Relationship to Owner:
Phone Number:
How did you hear about Island Dogs Canine Service?:
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Fun facts about your dog(s)!:
Submit
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