Boarding Intake Questionnaire Page 2
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1
2BOARDING INTAKE QUESTIONNAIRE
(Continued)
Complete this page if you are boarding more than 1 animal
PET #2 - INFORMATION
PET #3 - INFORMATION
Name: ______________________________________
Name: ______________________________________
Dog
Cat
Other
Dog
Cat
Other
(indicate below)
(indicate below)
______________________________________________
______________________________________________
Male / Female
-
Neutered / Spayed
Male / Female
-
Neutered / Spayed
Has pet been boarded before?
Yes / No
Has pet been boarded before?
Yes / No
Is pet socialized?
Yes / No
Is pet socialized?
Yes / No
Current on vaccinations?
Yes
No
Current on vaccinations?
Yes
No
Birthday: ____________________________________
Birthday: ____________________________________
Breed: ______________________________________
Breed: ______________________________________
Weight: _____________________________________
Weight: _____________________________________
Existing medical/health conditions:
Existing medical/health conditions:
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Allergies: ____________________________________
Allergies: ____________________________________
Disabilities: __________________________________
Disabilities: __________________________________
Restrictions:
(CIRCLE ANY THAT APPLY)
Restrictions:
(CIRCLE ANY THAT APPLY)
No jumping
No running
No hard play
No jumping
No running
No hard play
No contact w/other dogs (explain)
No contact w/other dogs (explain)
___________________________________________
___________________________________________
___________________________________________
___________________________________________
FOOD
FOOD
Type & amount _______________________________
Type & amount _______________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Where to feed ________________________________
Where to feed ________________________________
Morning
Morning
Procedure:
Procedure:
_____________________
_____________________
Afternoon
Afternoon
_____________________
_____________________
Dusk
Dusk
_____________________
_____________________
Night
Night
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