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Owner #1
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Daytime Phone Number |
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Evening Phone Number |
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Mobile Phone Number |
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Address |
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City |
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State |
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Zip Code |
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Email Address |
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Owner #2
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Daytime Phone Number |
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Evening Phone Number |
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Mobile Phone Number |
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Emergency Contact
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Phone Number |
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Would anyone else be authorized to pick up this dog? |
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Dog's Name
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Dog's Breed |
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Color |
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Weight |
pounds |
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Dog's Age |
years
months |
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Dog's Birthday |
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Dog's Sex |
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Spayed or Neutered? |
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If 'yes', at what age?
years
months |
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Have a tracking microchip? |
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Primary veterinarian |
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Address |
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City |
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State |
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Zip Code |
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Phone Number |
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Vaccinations |
Date last given: |
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Bortadella |
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Rabies |
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DHLPP |
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How long have you owned your dog? |
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How did you acquire your dog? |
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If adopted, please describe your dog's history
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Number of adults in household |
male
female |
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Number of children in household |
ages
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Does your dog share a home with other dogs? |
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If yes, how many? |
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Are they all spayed or neutered? |
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Sex of other dogs |
males
females |
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Breeds of other dogs |
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Ages of other dogs |
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Please list any additional animals at home |
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Briefly describe how your dog gets along with other
animals at home |
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Does your dog have any health considerations? |
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If so, what are they?
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Describe any restrictions on your dog's activities |
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List allergies |
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List any medications and what they are for |
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Is your dog on a flea and tick prevention program? |
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Is your dog on a heartworm program? |
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Describe your dog reaction to nail clipping |
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Describe your dog reaction to brushing |
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Are there areas on the body your dog does not like to
be touched? |
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Are there areas on the body your dog especially likes
to be petted? |
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Is your dog easily handled by you? |
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Is your dog easily handled by others (vet/groomer)? |
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Briefly describe your dog's exercise regimen |
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Briefly describe your dog's activity level |
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Has your dog attended daycare before? |
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If so, where?
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Describe your dog's personality |
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Is your dog sound sensitive to any noises? |
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Has your dog ever climbed or jumped over a fence? |
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Does your dog exhibit signs of separation anxiety? |
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Favorite treat |
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Favorite toy |
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Favorite activity |
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How does your dog react when you take away
toys, food or bones? |
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How does your dog react when others take away
toys, food or bones? |
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How often does your dog socialize with other people? |
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Describe how your dog reacts to visitors in your home |
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Describe how your dog reacts to other people while on
leash |
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Has your dog ever growled at someone? |
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If so, what were the circumstances
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Has your dog ever bitten someone? |
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If so, what were the circumstances
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Describe any kinds of people your dog automatically
fears or dislikes (tall people, people wearing hats) |
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Describe anything that makes your dog frightened or
nervous |
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Do visitors bring their dogs to your home? |
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If so, what is your dog's response
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How often does your dog socialize with other dogs |
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Does your dog participate in off-leash play with other
dogs? |
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If so, where and how often
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Describe how your dog reacts to other dogs while on
leash |
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Describe how your dog reacts to other dogs while off
leash |
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Describe how your dog reacts with puppies |
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Describe how your dog reacts with small dogs |
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Describe how your dog reacts with big dogs |
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Describe how your dog reacts with older dogs |
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Describe any sizes / breeds of dogs your dog
automatically dislikes |
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What kind of games does your dog play with other dogs?
(chase, tug, wrestle, etc.) |
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Has your dog shared food or toys with another dog? |
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Does your dog prefer to play with female dogs or
males?
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Has your dog ever bitten another dog? |
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If so, what were the circumstances
What was the extent of the damage
to the other dog?
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Is your dog crate trained? |
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What does your dog do when you are not home?
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Has your dog received any formal obedience training? |
If so, when and where
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List the obedience commands your dog knows |
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Dogs potty command |
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Dogs quiet command |
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Does your dog have a problem with: |
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How did you learn about us? |
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Other:
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