Boarding Intake Questionnaire
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2979-661-0840 ~
6955 Hummingbird Rd, Brenham TX 77833
BOARDING INTAKE QUESTIONNAIRE
PET #1 - INFORMATION
OWNER INFORMATION
Name: ______________________________________
Name: ______________________________________
Dog
Cat
Other
Address: ____________________________________
(indicate below)
City / ST / Zip: ________________________________
______________________________________________
Phones . . . Home: ___________________________
Male / Female
-
Neutered / Spayed
Work: ___________________________
Has pet been boarded before?
Yes / No
Cell: ___________________________
Is pet socialized?
Yes / No
Email Address: _______________________________
Current on vaccinations?
Yes
No
EMERGENCY CONTACTS:
Birthday: ____________________________________
Name: ______________________________________
Breed: ______________________________________
Phone: _____________________________________
Weight: _____________________________________
Name: ______________________________________
Phone: ______________________________________
Existing medical/health conditions:
VETERINARIAN:
______________________________________________
Name: ______________________________________
______________________________________________
Phone: ______________________________________
______________________________________________
City:
______________________________________
Allergies: ____________________________________
Disabilities: __________________________________
Restrictions:
(CIRCLE ANY THAT APPLY)
How did you learn about K’s Mutt Hut?
No jumping
No running
No hard play
If we were recommended, please tell us the
person’s name so we can say thank you.
No contact w/other dogs (explain)
__________________________________________
___________________________________________
___________________________________________
If there is anything else we should know about
FOOD
your pet that isn’t included in our questions,
Type & amount _______________________________
please tell us here:
(Indicate which pet this applies to.)
_______________________________________________
______________________________________________
_______________________________________________
______________________________________________
Where to feed ________________________________
______________________________________________
Morning
______________________________________________
Procedure:
_____________________
Afternoon
______________________________________________
_____________________
Dusk
______________________________________________
_____________________
Night
Use another sheet of paper if needed.
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