Pet Parent Name
*
Pet Parent #1 Phone
*
(###)
###
####
Email
*
Pet Parent #2 Name
Pet Parent #2 Phone Number
(###)
###
####
Emergency Contact (preferably local)
*
First Name
Last Name
Emergency Contact's Phone
*
(###)
###
####
Alternative Emergency Contact Phone Number
(###)
###
####
Dog's Name
*
Dog's Breed(s)
*
Dog's Age
*
Sex/Alteration Status
*
Male/Neutered
Male/Intact
Female/Spayed
Female/Intact
Veterinary Clinic/Preferred Veterinarian
*
Vet Clinic's Phone Number
*
(###)
###
####
Veterinarian's Address
*
I agree to cover any veterinary bills incurred and consent to my dog being treated at an emergency veterinary clinic at my cost.
*
All efforts will be made to contact you and your family veterinarian prior to going to an emergency clinic. In the unlikely event that medical attention is needed immediately and your veterinarian is unable to see you dog, he/she will be taken to VMCLI or VEG Commack.
Current Medications, Dosages, Instructions
Dog's Diet- Amount, Type, Feeding Times
*
Dietary Restrictions
Is your dog crate trained?
*
Yes
No
Working on it
How does your dog most often act when crated?
Crating/Confinement is a requirement, but I do everything in my power to make the dogs comfortable during confinement. Are there any particular things that make your dog feel more comfortable in a crate? Please Explain in detail.
What are your training goals and priorities for your dog's stay?
*
Please tell us what you'd like to be able to do with your dog
*
Please explain any known behavioral problems (n/a, if not applicable)
*
Any special instructions or things you want us to know about your dog
*
Has your dog ever bitten another dog or person?
*
