Please bring this form with you on the day of your dog’s first appointment. DOG PARENT INFO Name (LAST, FIRST): Address:
Apt #:
City:
State:
Home phone #:
Zip :
Cell phone #:
Emergency Contact:
Email:
Phone #:
Cell phone #:
❑ Friend/Family ❑ Internet ❑ Rescue League ❑ Community Event ❑ Other:
How did you hear about us?
DOG INFO Dog’s name: Gender:
Nickname:
❑ Male ❑ Female
/ Neutered/Spayed:
Breed:
❑Y ❑N
Weight:
Age:
Birthday:
Size:
Color:
❑ X-small ❑ Small ❑ Medium ❑ Large ❑ X-large
Identifying markings:
Personality traits: Aggressive with other animals? Allergies:
❑Y ❑N
/ Crate aggressive?
❑ Y ❑ N If yes, please list:
Other health issues:
❑Y ❑N
❑Y ❑N
If yes, please describe:
Vet:
❑ Rabies
Vet phone:
❑ Distemper
Expires:
❑ Bordetella
❑ Parvo-virus
Expires:
❑ B/T Kennel Cough
Expires:
Expires:
Expires:
STATE LAW REQUIRES YOU TO RELEASE VERIFICATION OF YOUR DOG’S RABIES DUE DATE. PLEASE BRING VERIFICATION PAPERS WITH YOU ON THE DAY OF YOUR DOG’S APPOINTMENT OR ASK YOUR VETERINARIAN TO FAX THEM TO US.
CARE HISTORY Approximately how often does your dog receive the following care? Bathing: Nail trimming: Ear cleaning: Teeth brushing:
❑ Daily ❑ Daily ❑ Daily ❑ Daily
❑ Weekly ❑ Weekly ❑ Weekly ❑ Weekly
❑ Every two weeks ❑ Every two weeks ❑ Every two weeks ❑ Every two weeks
Has your dog ever bitten or attempted to bite a person?
❑ Monthly ❑ Monthly ❑ Monthly ❑ Monthly
❑Y ❑N
❑ Quarterly ❑ Quarterly ❑ Quarterly ❑ Quarterly
❑ Yearly ❑ Yearly ❑ Yearly ❑ Yearly
❑ Never ❑ Never ❑ Never ❑ Never
What is the most important thing for us to know about caring for your dog?
SCE N T HO U N D DOG & DOG PARENT INFO / TERMS & CONDITIONS
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