Paws Away Client Form
Your Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Information
Back
Next
Pet Information
Please provide information regarding your pet(s)
*
Dog's date of birth (if known)
-
Month
-
Day
Year
Date
Is your dog neutered/spayed?
*
Is your dog up to date with vaccinations (please send us a copy or photo)?
*
Are there any health concerns we should be aware of?
Back
Next
Veterinary Information
Hospital Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Doctors Name
First Name
Last Name
Doctor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Does your dog have any kinds of people he/she automatically fears or dislikes (people in hats, on a bike, etc
How does your dog react to other dogs?
How does your dog react to strangers?
Has your dog ever bitten someone?
Has your dog ever been in a fight or bitten another dog?
Do you take your dog to off leash parks?
Has your dog ever swallowed something that required surgery to remove?
Has your dog ever escaped or attempted to escape by digging/jumping or climbing fences?
What exercise does your dog prefer?
Which commands does your dog know? What is his/her recall command?
Please describe your dog’s overall temperament:
Please list any additional instructions:
Signature
*
Submit
Should be Empty: