Dog Information Sheet Client Name ________________________________________________________ Dog's Name ________________________________________________________ Age _____________________ Breed ____________________________________ Sex: F M Neutered / Spayed ________________________________________ Rabies Tag # ________________________________________________________ Allergies ___________________________________________________________ Special Instructions ___________________________________________________ __________________________________________________________________ Medication To Be Administered _________________________________________ __________________________________________________________________ Traits: Friendly With Other Dogs Yes No Likes New Adults Yes No Likes Children Yes No Obeys Basic Commands Yes No Has Bitten Other People or Dogs Yes No Has Shown Other Aggression Yes No Dog's Temperament / Personality ________________________________________ __________________________________________________________________ Pet Reacts Badly To _________________________________________________ __________________________________________________________________ Example: Noise / Strangers / New Animals, Etc. Please Indicate Anything Else About Your Dog's Habits or Behavior That Would Be Useful To Us In Providing Care. ____________________ __________________________________________________________________ __________________________________________________________________ Has Pet Ever: Attacked Someone / Bit Someone Yes No Attacked Other Animals Yes No Injured Self / Escaped Out Of Fear Yes No Favorite Toys or Activities ______________________________________________ __________________________________________________________________ Pet Medical History Vet's Name _________________________________________________________ Clinic Name _________________________________________________________ Phone # ____________________________________________________________ Are There Food Allergies ______________________________________________ Are There Ongoing Or Reoccurring Know Illnesses ___________________________ __________________________________________________________________ Are Treatments & Medications Needed ___________________________________ __________________________________________________________________ Customer Emergency Contacts Customer Name _____________________________________________________ Phone # _________________________ Cell Phone # ________________________ Dogs Name _________________________________________________________ Alternate Contact Person_______________________________________________ Phone # ___________________________Cell Phone # ______________________ Relation ___________________________________________________________ |
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