New Client Intake Form
Thank you for your interest in working with us at Canines on Track. This form collects basic information about you and your dog and includes the client agreement required before participating in services. This form takes approximately 2–3 minutes to complete.
Client Information
Client Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
City/Area
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Dog Information
Dog's Name
*
Breed
*
Age
*
Birthdate (if known)
Sex
*
Female
Male
Is your dog spayed/neutered?
*
Yes
No
Approx. Weight (lbs)
*
Upload a photo of your dog. (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
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Vet Information
Vet Clinic Name
*
Vet Clinic Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
May we contact your vet in case of emergency?
*
Yes
No
Emergency Care DisclaimerIn a medical emergency, every effort will be made to contact you and go to your preferred vet. If unavailable, your pet may be taken to the nearest clinic. All emergency costs are the owner’s responsibility.
*
I acknowledge and agree to this Emergency Care Disclaimer.
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Health Basics
Is your dog up to date on vaccinations? (vaccination record is required prior to booking) Required vaccines are DHPP, Rabies & Bordetella.
*
Yes
No
Does your dog have any medical conditions?
*
Does your dog have any known allergies?
*
Does your dog require any medications?
*
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Behaviour
Has your dog ever bitten anyone?
*
Yes
No
If yes, please explain.
Has your dog ever showed any reactivity/aggression to people or other dogs?
*
Yes
No
If yes, please explain.
Does your dog get along with other dogs? (Please note that for all of our services, except Private Training Sessions, it is mandatory that we only accept dogs who get along with other dogs and enjoy being social)
*
Yes my dog is friendly and enjoys being around other dogs.
No, my dog does not enjoy being around other dogs.
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Service Interest
What service are you interested in? (select all that apply)
*
Private Training
Puppy Imprinting (for dogs under 6 months old)
Board & Train (for dogs 6 months and older)
Boarding
Daycare or Day Training
Enrichment & Adventure Services
Not sure / need guidance
Briefly describe what brings you to Canines on Track today.
*
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Training Info
What, if any, previous training has your dog had?
What cues does your dog currently know?
Do you have an behaviour concerns?
What are your training goals?
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Boarding Info
Is your dog crate trained?
Yes
No
Does your dog currently use a crate?
Yes, overnight and when unsupervised.
Yes, but only overnight.
No
Is your dog housetrained?
Yes
Yes, but as the occassional accident inside.
No
Does your dog experience separation anxiety?
Yes
No
Can your dog be safely left alone? (please note that your dog will be supervised and not left alone for long periods of time.)
Yes
No
What is your dog's feeding schedule? (amount of food and frequency of feedings during the day - also include if they receive supplements/daily treats)
What is your dog's sleep routine? (When do they typically go to bed/wake up, where are they most comfortable sleeping, do they require a bathroom break overnight)
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Daycare Info
Has your dog ever attended daycare before? If so, what was their experience like?
What is your dog's playstyle with other dogs?
Does your dog exhibit any guarding behaviours? (example: toys, food, people)
What is your dog's energy level?
Low
Medium
High
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Enrichment / Adventure Info
Off-Leash Reliability (Sniffari Walks and Puppy Passport Outings are typically done on leash, with few exceptions at the approval of the owner)
Poor
Fair
Good
Excellent
Recall Reliability
Poor
Fair
Good
Excellent
Comfort with New Environments
Very anxious
A little nervous
Neutral
Very adventurous
Car Travel Comfort
Type option 1
Type option 2
Type option 3
Type option 4
How does your dog typically travel in the car? (front seat, back seat, in a crate, loose in the car, etc.)
Does your dog typically experience car sickness?
Yes, often
Occassionally
Never
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Continue
Continue
Client Acknowledgement & Confirmation
*
I confirm all information is accurate and agree to Canines on Track service policies and liability waiver.
Client Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Should be Empty: