Dog
I nformation
( Complete
O ne
f or
E ach
D og)
Dog’s
N ame:
_ _________________________________
G ender:
_ ____
M ale
_ ____
F emale
Age:
_ ___________
B irthdate:
_ ___/____/____
W eight:
_ _____________
Breed:
_ ____________________________
C olor/Markings:
_ _________________________
Spayed
o r
N eutered?
_ ___
Y es
_ ___
N o
I f
n o,
s urgery
i s
s cheduled
f or:
_ ________________
(Dogs
o ver
7
m onths
o ld
m ust
b e
s payed
o r
n eutered
t o
a ttend
d aycare)
How
l ong
h ave
y ou
o wned
y our
d og?
_ _____________________________________________
Where
d id
y ou
g et
y our
d og?
_ ___________________________________________________
Basic
H ealth
I nformation:
Does
y our
d og
h ave
a ny
a llergies?
_ _________
If
s o,
p lease
d escribe:
_ __________________________________________________________
Does
y our
d og
h ave
a ny
s pecial
m edical
p roblems?
_ _________
If
s o,
p lease
d escribe:
_ __________________________________________________________
Does
y our
d og
h ave
a ny
o rthopedic
c oncerns?
_ _________
If
s o,
p lease
d escribe:
_ __________________________________________________________
Social
S kills:
How
w ould
y ou
d escribe
your
d og’s
P ersonality?
_ ________________________________________________________
Is
y our
d og
m ore
d ominant
o r
m ore
s ubmissive?
_ ____________________________________
Is
y our
d og
c rate
t rained?
_ ________
Does
y our
d og
l ike
C hildren?
_ ____
M en?
_ ____
W omen?
_ ____
Please
l ist
o ther
p ets
i n
h ousehold:
_ _______________________________________________
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