Client Intake Form "*" indicates required fields Name* First Last Address Email* Phone*Dog's Name* Breed* Age* Sex* Spay/Neut.?* Referred By Other Pets in Household Other People in Household Occupation/Time spent outside home Veterinarian Medical Problems/meds/allergies Brand of Food How many times per day? What times is dog fed? Eat right away/finish meals? Other treats/snacks & how often Where was dog obtained/How long ago Housebroken? Yes No Crate Trained? Yes No Where does dog sleep? % time indoor/outdoor? Where kept when the owner is gone? Any previous training? Behaviors dog knows/training methods used/trainerExercise Type/Frequency Equipment used on walks Has dog ever bitten or injured a person or animal? Yes No If yes, describeReason for ConsultationDate* MM slash DD slash YYYY Signature*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
