Intake Form (Daycare & Boarding)

Utopia for your pet…
Peace of mind for you!

Today’s Date *

Owner’s Name *

Address *

Email Address *

Phone Numbers (Home, Work, Cell, etc.) *

Alternate Contacts While You’re Away (Names & Numbers) *

Best Way to Contact You While You’re Away

Name of Veterinarian *

Clinic Phone Number *

Dog’s Name *

Breed *

How does your dog socialize with other dogs? *

Dog’s Date Of Birth *

Has your dog ever been separated from you before? *

How does your dog handle being separated from you? *

Is your dog spayed / neutered?: *

Does your dog have any chronic illnesses? (Please list) *

Does your dog have any allergies? (If so, please list) *

Is your dog microchipped? *

Medication for illness (Please list, with any instructions)

Are all shots are up to date? *

Does your dog have flea protection?: *

Is your dog protected from heart worm disease? *

What brand food does your dog eat? *

Feeding Schedule (Quantity & Frequency) *

What is your dog’s daily schedule like? (Walks, bathroom breaks, etc.) *

Does your dog have any anxieties? e.g. thunder, fireworks, rain *

If your dog suffers from anxieties, how do you comfort him/her? *

Where does your dog usually sleep? *

Do you use a crate? *

Is your dog house trained? *

How Did You Hear About Our Services? (Please Specify) *

Please provide details regarding referral (name? social media – pls specify which platform. Other: vet, trainer, groomer, pet store etc…)

Anything else you feel is important for us to know about your dog?

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