Please provide the following Owner information:

Owner Title	Mr, Ms, Mrs Mr. Ms. Mrs.
First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
Work Phone
Cell Phone
E-mail

Please provide the following Emergency Contact information:

First Name
Last Name
Title	Mr, Ms, Mrs Mr. Ms. Mrs.
Home Phone
Other Phone

Please provide the following Dog information: Please submit an additional form for each additional dog.

Dog Name
Dog Breed	Breed Afghan Airdale Akita Alaskan Malamute American Eskimo Australian Cattle Dog Australian Shepherd Basenji Bassett Hound Beagle Bearded Collie Bedlington Terrier Belgian Shepherd - Malinois Bernese Mtn Dog Bichon Frise Border Collie Bouvier Boxer Brittany Spaniel Bulldog Bullmastiff Cairn Terrier Cavalier King Charles Chesapeake Bay Retriever Chow Clumber Spaniel Cockapoo Cocker Spaniel Collie Dachshund Dalmation Deerhound Doberman Elkhound English Springer Spaniel English Setter Flat-Coated Retriever German Shepherd Golden Retriever Gordon Setter Great Dane Great Pyrenese Greater Swiss Mountain Dog Greyhound Havanese Irish Setter Irish Wolfhound Italian Greyhound Italian Spinone Jack Russell Terrier Keeshonden Kuvasz Labrador Retriever Leonberger Lhasa Apso Maltese Newfoundland Old English Sheepdog Pekingese Pit Bull Pointer Polish Lowland Sheepdog Pomeranian Poodle - Mini or Toy Poodle - Standard Portugese Water Dog Pug Puli Ridgeback Rottweiler Russian Wolfhound - Borzoi Saint Bernard Saluki Samoyed Schipperke Schnauzer - Giant Schnauzer - Miniature Scottish Terrier Shar-Pei Shetland Sheepdog (Sheltie) Shiba Inu Shih Tzu Siberian Husky Silky Terrier Soft-Coated Wheaten Terrier Tervueren Shepherd Tibetan Mastiff Tibetan Terrier Viszla Weimaraner Welsh Corgi - Pembroke or Cardigan Welsh Springer Spaniel West Highland White Terrier Whippet Wire-haired Pointing Griffon Yorkshire Terrier (Other)
Other
Sex	Male Female
Altered	Spayed Neutered No
Birth Date
Weight

Please provide the following Veterinarian Contact information:

Clinic Name
Veterinarian Name
Address
Office Phone
FAX

Others Authorized to Pick Up Your Dog

Authorized #2

Authorized #3

Secret Password

Todays Date

-- mm/dd/yy

 

Pet Personality Profile

General Information

How did you hear about The Learning Center at Dog Wash Express & Spa?

How long have you owned your dog?

If adopted, do you have knowledge of your dog's past history? If yes, please describe:

How many people are in your household?                                       Adult Males 1 2 3 4 5 6                      Adult Females 1 2 3 4 5 6                                           Number of children and their age/sex

Does your dog like children?    Yes or No Yes No

Describe how your dog behaves around children

List other animals in your household (Species/Breed/Altered/Age/Sex)

Describe how your dog gets along with other animals in your household:

 

Health and Grooming

List any current medical problems your dog has:

List any chronic medical problems your dog has:

Does your dog take any medications regularly? If so, list:

Will these medications need to be administered in daycare?

Does your dog have hip dysplasia? If yes, what restrictions will need to be placed on your dog's activities and movements?

Does your dog have any allergies? Please list:

Does your dog have any food sensitivity issues? Please list:

What dog food do you feed and what feeding schedule are you on?

Does your dog have a problem with fleas?

How often do you brush or comb your dog?

Does your dog like to be brushed? If not, what have you tried to make brushing more enjoyable for your dog?

How does your dog react to having his/her nails clipped?

Does your dog have any sensitive areas on his/her body?

Where are your dog's favorite petting spots?

Behavior

Do visitors bring their dog(s) to your home? Select Yes or No Yes No If yes, how does your dog react?

How does your dog react to a stranger coming into your home or yard?

Does your dog ever bark or growl at anyone passing outside your home or yard? Select Yes or No Yes No

Are there any kinds of people your dog automatically fears or dislikes? If so, who?

Are there any kinds of dogs your dog automatically fears or dislikes? If so, who?

How does your react to puppies?

What does your dog do when your not home?

How does your dog act when you get home at the end of the day?

What does your dog do to show he/she is happy?

How does your react to strange dogs approaching it when you're out on a walk?

        a) On lead

        b) Off lead

How many times each week is your dog walked outside?

How long are your walks?

Has your dog ever jumped on someone? (Select Yes or No) Yes No What were the circumstances?

Has your dog ever growled at someone? (Select Yes or No) Yes No What were the circumstances?

Has your dog ever bitten someone? (Select Yes or No) Yes No What were the circumstances?

Has your dog ever climbed or jumped over a fence? (Select Yes or No) Yes No How high was it? (Select One) Not Applicable 2 Feet 3 Feet 4 Feet 5 Feet 6 Feet

Does your dog have any problems in the following areas? If yes, please describe:

            Mouthiness                (Select Yes or No) Yes No

           Housetraining            (Select Yes or No) Yes No

              Barking                       (Select Yes or No) Yes No

              Digging                       (Select Yes or No) Yes No

              Ignoring Commands (Select Yes or No) Yes No

Is your dog frightened by any noises? (Select Yes or No) Yes No Describe:

Is your dog frightened or nervous around anything else? (Select Yes or No) Yes No Describe:

Has your dog ever growled or snapped at anyone taking food or toys away?     (Select Yes or No) Yes No

Has your dog ever shared his/her food or toys with other animals?         (Select Yes or No) Yes No

Does your dog play with any toys?     (Select Yes or No) Yes No

What kind of toys does your dog like and what games does he/she play with the toys?

What kind of games does your dog play with people?

Does your dog know any tricks?        (Select Yes or No) Yes No

If yes, describe and list commands?

Has your dog ever been on agility equipment? (Select Yes or No) Yes No

Has your dog ever had any formal obedience training?        (Select Yes or No) Yes No

If yes, when and where?

What obedience commands does your dog know?

Do you walk your dog on your left or right side? (Left or Right) Left Right

What kind of collar do you use when you walk your dog?

Is it effective in keeping him/her under control? (Select Yes or No) Yes No

Does your dog know any hand commands?          (Select Yes or No) Yes No

If yes, what are they?

Does your dog have a bathroom command?        (Select Yes or No) Yes No

If yes, what is it?

Does your dog have any play (e.g.: "you're free") commands?        (Select Yes or No) Yes No

If yes, what are they?

Does your dog have a quiet command?               (Select Yes or No) Yes No

If yes, what are they?

Other comments or information about your dog that you feel might be helpful: