Client Intake Form "*" indicates required fields Name* First Last AddressEmail* Phone*Dog's Name*Breed*Age*Sex*Spay/Neut.?*Referred ByOther Pets in HouseholdOther People in HouseholdOccupation/Time spent outside homeVeterinarianMedical Problems/meds/allergiesBrand of FoodHow many times per day?What times is dog fed?Eat right away/finish meals?Other treats/snacks & how oftenWhere was dog obtained/How long agoHousebroken? 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/FrequencyEquipment used on walksHas 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.
