Information Sheet
General Information:
Name: ____________________________________ Pet’s Name _________________________
Address: _________________________ City: ________________ Sate: __ Zip Code: _______
Home Phone: ____________________________ Cell Phone: ___________________________
E-Mail Address : _____________________________ (Happy Tails will send periodic e-mails to
clients. If you prefer not to receive these please check here) _______
Breed: _______________ Date of Birth: ______ Sex: _______ Spayed/ Neutered: _________
Veterinarian: _______________________________ Phone Number: ____________________
Emergency contact: ____________________________________ Phone #: ________________
Referred by whom: (referrals = one free day for the dog who referred you.)
____________________________________________
Allergies: ____________________________________________________________________
Has your dog ever been in Day Care before: _________ If so, where: ____________________
Medical History:
Vaccination dates: Rabies: _______ DA2PP ________ Bordatella: ________ (Please provide proof)
Do you have an annual heartworm test?: _______
If yes, what brand of preventative do you use: _____________________________________
Flea/Tick Medication? ______ If yes, what brand of preventative? _______________________
Describe any medical issues that we need to be aware of: (hip, heart, seizures, etc.)
Does your dog take daily medication? ______ If yes, what type? _________________________
Has your dog been diagnosed with a contagious disease in the past 30 days? ____ If yes, what?
______________________________________________________________________________
Microchip #: ___________________________________ Brand _________________________
Tell us about your dog:
How long have you had your dog? _________ Where did he/she come from? _______________
If adopted from a shelter, what do you know about his/her history?
Please describe your family: (please include number and ages of children)
Please tell us about any other pets in your household:
Has your dog ever reacted aggressively toward a cat? __________
Has your dog had obedience training: _____ If yes, what level: __________________________
Is your dog comfortable in a crate? ________
Has your dog ever jumped over a fence? _____ If yes, how high was it? ___________________
Has your dog ever growled or snapped if you touch his/her food or toys? __________________
Has your dog ever protected his/her food/toys from another dog? _________
Would you say that your dog plays nicely with other dogs? _______
Has your dog ever disliked another dog? ___________
How does your dog react to puppies/small dogs? ______________________________________
How does your dog react to strangers? ______________________________________________
Has your dog automatically disliked anyone? _______ If yes, who? ______________________
Does your dog have any behavior problems that we should be aware of:
Thank you for sharing this information with us. It will make your dog's stay with us much more enjoyable.
HAPPY PETS HAVE HAPPY TAILS!
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| Happy Tails Day Care & Pet Resort 11929 E. Corning Rd. Corning, NY 14830 phone: 607-377-5757 happytails1@stny.rr.com DAY CARE APPLICATION |
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