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Pet Profile Form
Step
1
of
3
33%
Owner's Name
First
Last
Your Address
Street Address
City
State
ZIP / Postal Code
Email Address
Phone Number
Pet's Name
Pet's Age
Breed
SEX
Male
Female
Spayed or Neutered ( Yes or No )
Yes
No
How long has your pet lived with you? (years/months)
When and where did you acquire your dog?
Where did you acquire your pet?
If adopted, please share what you know about your pet's history.
Name of Current Veterinary Hospital? (NOTE: Bordetella, Distemper & Rabies Vaccines MUST be Updated)
Name of Flea/Tick Control and Prevention Program? (NOTE: Prevention is MANDATORY)
Why is your pet coming today for an Evaluation? (check all that apply)
Boarding soon
Would Like to Attend Daycare/become Better Socialized
Would Like to Attend Daycare to get exercise
Does your pet have any allergies? ( Please Select One )
Yes
No
Does your pet have any existing medical conditions? ( Please Select One )
Yes
No
If YES Please explain
Number of cats in household
Number of dogs in household
How does your dog get along with other household pets?
Indicate the following from the overall level of exercise that best describes your dog's routine
Couch potato
Mild exerciser
Moderate exerciser
Athlete
Indicate from the following the level of dog socialization that best describes your dog's routine
None (No knowledge of other dog interaction)
Minimal (On lead encounters only)
Moderate (Some off-lead playtime on occasion with visitor's/neighbor's/friend's dog)
Extensive (Regular visits to dog social events, off lead dog parks, dog daycare)
My pet plays well with?
Males Only
Females Only
Males and Females
Are there any particular types of people your pet seems to automatically fear or dislike?
Are there any types and/or breeds of dogs that your pet seems to fear or dislike?
How does your dog react when approaching another dog on leash?
How does your dog react when approaching another dog off leash?
Has your pet ever been attacked or bitten by another dog?
Yes
No
If yes, please explain circumstances.
Food/Toy Aggressive or Possessive? (please circle one)
Yes
No
Are there any types of People your pet seems to fear or dislike? Please explain
Has your pet ever growled at someone?
Yes
No
Has your pet ever bitten someone?
Yes
No
Please explain
What does your pet do to show he/she is happy?
Please explain
Has your pet ever climbed/jumped or dug under a fence?
Yes
No
Please explain
Is your pet afraid of any specific items or noises?
Yes
No
Please explain
Is your pet frightened of thunderstorms?
Yes
No
If yes, please describe his/her behavior and what you do to calm him/her down.
Describe your pet’s prey drive (will chase smaller animals i.e. squirrels/birds)
Does your pet resource guard (Ex. water/food bowl or toy/bone protective)
Yes
No
Please explain
What does your pet do to show he/she is happy? (check all that apply)
Happy barking
Running
Rolls over for belly rubs
Spinning/Dancing
Other:
What kinds of games does your pet play with people?
Has your dog had any formal obedience training?
Yes
No
What commands does your pet know?
When and where?
What commands does your pet know?
What else would you like to tell us about your pet?
Your name
First
Last
Date
MM slash DD slash YYYY
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