Fields with * are required

Owner Name:* Address:* Home Phone No: Mobile:* Email:*

Dog Name:* Breed:* Date of Birth:* Dogs Age: Choose 3-6 Months 6-9 Months 1 Years 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years

Is your dog micro-chipped?:* yes no

If YES what is micro-chip number

Is your dog?:* Male Female

Neutered:* Yes No

Food Type:

Vet Clinic:* Treating Veterinarian:* Vets Telephone:*

Has your dog ever been enrolled in a doggie day-care or any boarding facility before?:* Yes No

If YES where?:

Please provide us with two emergancy contacts including phone numbers.

Contact Person 1 & Telephone No:* Contact Person 2 & Telephone No:* Contact Person 3

Do your have pet insurance?: Yes No

Insurance Company:

**You must bring along your dog’s vet vaccination cert on assessment day""

Is your dog up-to-date with their yearly vaccinations? Yes No

Date of Last Vaccination?:

Has your dog had his/her kennel cough vaccination? Yes No

Has your dog been wormed?: Yes No

List any known allergies?:

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Any medical/health issues we need to be aware of?:

Does your dog need medication for any illness or ailment?: Yes No

If yes please give details?: Does your dog sleep indoors or outdoors at night?: Indoors Outdoors

Is your dog toilet trained? Yes No

Has your dog ever shown any aggressive tendencies towards?:

Food

Dog

Toys

People

Children

Never

If yes to any of the above please give details:

Has your dog ever bitten a person or another dog?: Yes No

Has your dog ever been bitten or attacked by another dog?: Yes No

If so please give details:

Does your dog play with other dogs on a regular basis?: Yes No

Does your dog have any fears or phobias?: Yes No

If yes please explain:

Where did you hear of the Dog Ranch?: Choose Google Pet Directory From a Friend From Local Vet Facebook Road Sign Other

Are you be interested in?:

Dog Day-care

Dog Vacation

Dog Training

Puppy Play School

Dog Behaviour

One-2-One

Other

Is there any other information about your dog that you feel we should be aware of?: