I RrrFF-N-lt S - Ruff-N

I
RrrFF-N-lt S
loggie D?gcile rrc
Customer Questionnaire
Name:
Address:
Mailing Address:
Home Telephone:
CellTelephone:
Work Telephone:
Email:
Please provide a list of people who may pick up your pet:
Pet lnformation
Pet Name:
Breed:
Gender:
Spayed/Neutered? Y/N (circle one)
Weight:
Birth date:
Veterinarian lnformation
Name:
Address:
Phone:
Emergen cy{ont astJ
nfo
rmatlon
Telephone:
Name:
Page
t of
5
96o Gendron Road
Jay, W 05859
8o2.744.2582
8oz.3ro.z58z
fi Rurr-N{t f$
|oggie D?gcile rrc
Customer Questionnaire
Doggie Basics...
How old was your dog when you got him/her?
Where did your dog come from? (breeder/shelter)
lf your dog was adopted, please tell us about his/her past experiences:
How do you socialize your dog? (playdate, daycare, dog park)
Has
your dog been to a dog daycare before?
How does your dog interact with children? Other pets?
Has
your dog ever growled at anyone? lf yes, please describe the situation:
Doggie Health...
ls your dog currently up-to-date on all vaccinations? (Rabies/Bordatella/DHLPP)
Page z of
5
96o Gendron Road
Jay, W 05859
8o2.744.2582
8oz.3to.z58z
{$ Rrlrr-N-lt {$
loggie D3gc3[e uc
Customer Questionnaire
Doggie Health ... (continued)
Has
your dog ever experienced
a
flea or tick problem? Yes I No (circle one)
lf yes, when?
What flea/tick preventative do you currently use?_
Does your dog require specialized
attention due to allergies/health issues? (hip
dysplasia)?
ls your dog currently taking medication, or in need of restricted activity?
Tell us about your dog's typical daily routine, including amount of exercise:
Doggie Training/H istory...
Has
your dog had obedience training? (Please list trainerffacilities):
Please list the commands your dog knows:
ls your dog crate-trained? Yes I No (please circle one)
I
s he/she
food/toy/attention-driven?
What is your dog's favorite treat/toy/game?
Are there any food or treats your dog cannot have?
Page 3
of
5
96o Gendron Road
Jay, W 05859
8o2.744.2582
8oz.3ro.z58z
f$ RrJFF-N-lt f$
loggie D1gcile 11c
Customer Questionnaire
Doggie Training/History (continued)
Does your dog ever experience separation anxiety? Yes I No (please circle one)
lf yes, please describe intensity/situation:
How does your dog greet strangers?
Does your dog display any possessiveness over toys/people or other dogs?
Does your dog do any of the
following:
Jumoing
uo
IU
Charging (dogs or people)
Digging
Excessive barking
Escaping/running
Mounting
Other(explain below) Fear of men
Please explain the main reason you
would like to bring your dog to daycare?
How did you hear about us?
Page 4
of
5
96o Gendron Road
Jay, W 05859
8o2.744.2582
8oz.3to.z58z
S Rurr-N'lt fI.
poggie D1gcile rrc
Customer Questionnaire
Doggie training/History (continued)
Has your dog ever
bitten a human?
Yes/No
(please circle one) tf yes, explain the situation
and the number of times and circumstances.
to fight with other dogs? Yes/No (please circle one)
lf yes, delineate the number of times and circumstances.
Does your dog have the tendency
It is understood that this information sheet becomes and is hereby incorporated in the
Ruff "N" lt Doggie Daycare, LLC Boarding Contract.
the owner of the pet and, hereby swear and affirm that the above statements are true
and accurate to the best of my knowledge and belief and as to the statements based upon my
belief I believe them to be true.
I am
Date
Pet Owner
Page 5 of 5
96o Gendron Road
Jay, W 05859
8o2.744.2582
8o2.3'to.z58z