New Client-New Pet Questionnaire
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- Veronica Robbins
- 6 years ago
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1 New Client-New Pet Questionnaire Date: Your Name: Address: City, State: Zip: Phone: (H) (W) (C) address: Emergency Contact Name & Phone Number: Pet s Name: Breed: DOB Color: Sex: Neutered Male Intact Male Spayed Female Intact Female Veterinarian Name & Clinic: How long have you had your pet? From where did you obtain your pet? Is/Was your pet CRATE TRAINED? Is your pet HOUSETRAINED? How many hours is your pet accustomed to spending in a crate on a daily basis? Does your pet have any food allergies? If so, please list: Do you have any objections to us giving your pet treats? Is your dog on any medications or does she/he have any medical problems that we need to be aware of? Please list and explain: Does your pet suffer from any chronic illnesses (seizures, stress diarrhea, etc.)?
2 Please answer the following questions as thoroughly as possible: Does your pet guard objects or food from people? If yes, please explain. Has your pet ever growled, snapped at or bitten a person? If yes, please explain. Has your pet boarded or been to day care at another facility? If so, was it a positive experience for your pet? Has your pet been in an altercation with another dog? If yes, please explain. Is your pet afraid of thunderstorms? If yes, does she/he have medication (type and dosage)? Has your pet ever jumped or climbed a fence? If yes, list type and height of fence. Does your pet have any behavioral problems that we should be aware of? (for example, doesn t like small dogs, men, women, children, strangers, other dogs; doesn t like collar or a specific part of body touched, eats rocks etc.) How did you hear about us? Please check one Google Angie s List Yelp Friend Bing Care.com Phonebook Name Yahoo Facebook Website Other Thank you very much for your time. DogServices goal is to provide a fun and safe environment for your pet. Database Employee Initials Bonus Bonz Date
3 Dear Client: In accordance with the Virginia Comprehensive Animal Laws, DogServices is required to provide to you the following notice each time your pet boards overnight or stays the day for daycare. Please read the following statement and sign at the bottom acknowledging you have been made aware of the information listed below. NOTICE The boarding of animals is subject to Article 4 ( Et. Seq.) of Chapter 65 of Title 3.2. If an animal becomes ill or injured while in the custody of a boarding establishment or groomer, the boarding establishment or groomer shall provide the animal with emergency veterinary treatment for the illness or the injury. The consumer shall bear the reasonable and necessary costs of emergency veterinary treatment for any illness or injury occurring while the animal is in the custody of the boarding establishment or groomer. The boarding establishment or groomer shall pay for veterinary treatment for any injury that the animal sustains while at the establishment or under the care or custody of a groomer if the injury resulted from the establishment s or groomer s failure, whether accidental or intentional, to provide the care required by , or if the injury is a result of the actions of the boarding establishment or groomer. Boarding establishments and groomers shall not be required to bear the cost of the veterinary treatment for injuries resulting from the animals self-mutilation. Printed Name: Date: Signature: Dog s Name: DogServices Rep: Date: Boarding Doggy Daycare Grooming Training
4 Name Dog s Name IMPORTANT EMERGENCY INFORMATION Since an emergency may happen at any time with your dog, please take the time to have your wishes recorded below. This information is most critical for our staff and any emergency room personnel. During your dog s stay our staff will make every effort to contact your listed veterinarian for any medical emergency or medical information. However, after hours, weekends, and holidays, we must use the Dogwood Veterinary Emergency & Specialty Center or Veterinary Referral & Critical Care. Every time you leave town and your dog is in our care, please check with your listed emergency contact to make sure they ll be available to transport your dog to and from the veterinarian s office, Dogwood or VRCC. Your emergency contact also needs to know a history of any medical problems that you may have experienced with your dog. For example, if your dog sometimes limps after playing ball, gets diarrhea easily, or occasionally is lethargic and cranky, it would be helpful to have that history available. Then if your dog exhibits these same behaviors when in our care, your contact person will know this is normal for your dog. When your emergency contact person is not available, we will transport your dog either to your veterinarian s office, Dogwood or VRCC. Our customary charge is $25.00 per trip. If our staff transports your dog, we need to convey your wishes during your absence. Listed below are some questions that need careful consideration. We want to assume no responsibility for any decision that would normally be made by you, your family, and your personal veterinarian without your approval. 1. If it is not life threatening, do you want x-rays taken? Yes No 2. If it is not life threatening, do you want blood work done? Yes No 3. If it is not life threatening, do you want the vet to do the minimum to keep your dog comfortable until your dog can be transported to your personal vet or do you want the emergency room vet to complete treatment? a. Minimum only b. Complete treatment b. If complete treatment is selected, do not exceed $ 4. If surgery is involved (for example, bloat) please consider the following: a. Complete the surgery no matter what the cost b. Complete the surgery with a maximum cost of $ 5. If a decision is made not to do the surgery and euthanasia is recommended how would you like to have the emergency room personnel dispose of your pet s body? a. Refrigerate until I return and I will pick up my pet b. Private cremation with ashes returned to me c. Cremation with no return of ashes d. Public disposal Thank you for taking the time to consider these options. We know it is never easy making such decisions about your dog. All of the staff at DogServices are dog lovers and absolutely can relate to these tender decisions. Owner Signature: Date:
5 Dear Clients: After speaking with several area veterinarians, we wanted to take this opportunity to discuss Tracheobronchitis, also known as canine cough or kennel cough. It is airborne, has an incubation period anywhere from 3 to 5 days, and can be either viral or bacterial depending on its source. When dogs are placed into group situations such as daycare, boarding, dog parks, training classes, visiting your vet or pet store and play dates at home, they can be exposed to the organisms that cause Tracheobronchitis, even if the other dogs are vaccinated. Dogs can carry the infection without becoming or seeming to be symptomatic themselves. There have been instances where dogs were walked through their neighborhood, and because the organism is airborne, they have contracted canine cough. The most common cause of Tracheobronchitis is Bordetella Bronchiseptica, a bacterial infection. Immunity to this infection is not long-lasting even after the dog has been infected with the illness. Immunity lasts 6 to 12 months in most dogs, and when it wears out, they are susceptible to the infection again. This is why many veterinarians are now recommending biannual vaccinations. The most common symptom of Tracheobronchitis is a dry, hacking cough that may end with the dog retching. If your dog exhibits these symptoms, a visit to your veterinarian can put your dog back on the path to wellness. All of the organisms that cause this illness appear to be highly contagious, so it is not unusual for all dogs in a household to become infected. We highly recommend that you consider having your dog s Bordetella vaccination done biannually to protect him/her as well as their playmates. The average cost of this vaccination is $20-$30, and we think it is well worth your peace of mind and your pet s health. Sincerely, Yvonne McDaniel Executive Manager Boarding Doggy Daycare Grooming Training
6 Dear Clients, Thank you for choosing DogServices for your boarding, daycare, grooming, and training needs. The staff at DogServices strives on a daily basis to provide you and your pet with the best care available. Due to our increasing number of clients, we wanted to take this opportunity to reemphasize important policies with all of our customers. Recognizing and following these policies will ensure a safe and welcoming environment for you and your pet. When dropping off and picking up your pet, please adhere to the following: All dogs need to be leashed when entering the building. We ask that you do not use retractable leashes because sometimes they don t retract. Although your dog may not normally require a leash, having them leashed at all times limits their exposure to unfamiliar dogs, thus reducing opportunities for unwanted contact and altercations. All dogs need to wear a snap collar when they are here for daycare or boarding. It is hard for our staff to handle your dog with no collar. For safety purposes, we request that dogs do not wear training collars, choke collars, martingale collars, or shock collars to DogServices. Additionally, identification tags need to be attached to collars at all times. This is not only to ensure the safety of your dog, but also to assist staff in accurately identifying your pet. (It can be difficult to identify all black Labs with red collars, for example.) Reservations need to be made for daycare and boarding prior to your dog s visit. At DogServices, we team each dog based on personality and play style. We team calm dogs with calm dogs, energetic dogs with energetic dogs, etc., to ensure that experiences at DogServices are fun and safe. DogServices is open Monday through Friday 7:30am to 6:00pm and Saturday and Sunday 9:00am to 6:00pm. If you are unable to pick up your dog during these hours, please notify us in advance so that we may accommodate you if possible. We sincerely appreciate your understanding and cooperation in this matter. Thank you again for choosing DogServices. We look forward to your next visit. Sincerely, Yvonne McDaniel Executive Manager Boarding Doggy Daycare Grooming Training
7 Dear Friend: The whole staff joins me in welcoming you and your pet to our facility. We are happy you have chosen us for your pet s home away from home needs. Hopefully, you are already doing some training with your pet at home. The training that is provided here should be an extension of your total training program and not your pet s primary training source. You will find an attached list of Commands or Training Vocabulary that is used when your pet comes to our facility. There is also a brief explanation of what each command means. If your pet already knows a specific command for a behavior, please inform the receptionist of the command at check-in so the staff does not confuse your pet. Dogs that come to us vary a great deal in size, shapes and breeds. They also vary in personality ranging from submissive and emotionally fragile to physically tough and any combination in between. It is very important to choose the proper training technique for you and your pet to ensure success. Training a dog does not mean yelling a command and expecting your pet to understand you. You must teach what the command means and what it is that you want from your pet. The right motivation is critical to the success of your training. A wide variety of motivational training equipment is used at our facility. Some examples are toys, slip collars, and gentle leaders. Food rewards, such as hot dog pieces, cheese, peanut butter, and doggie cookies are also used with your permission. Choosing the correct equipment and rewards for your pet is an important key to successful training. If you do not currently work with your pet at home and would like to start doing so but are not sure how, please speak with the receptionist about scheduling a training session. We will be happy to get you started and help you continue on the path to successful training. If you need to breathe some new life into an old training routine, we can help you choose a new approach for reinforcing current training or help you develop a new training method for you and your pet. Sincerely, Yvonne McDaniel Executive Manager Boarding Doggy Daycare Grooming Training
8 TRAINING VOCABULARY WITH ME To walk along side on a loose leash rather than pulling GO Go play ; Go find a toy; Go Away MOVE IT To move out of the way COME To come to the front of human no matter what pet is doing SIT To sit DOWN To lie down OFF To get feet off of whatever they are on (people, furniture); All four feet on ground WAIT To wait where pet is until given the command to do something else (to wait while door is opened and then given command to go forward) STAY To stay where pet was positioned until human returns to you and releases ENOUGH Enough of whatever it is pet is doing (barking, playing tug) SETTLE Settle the enthusiasm LEAVE IT Whatever the pet s nose is in is to be left alone and they are to back off from the object TAKE IT Whatever the pet s nose is in may be taken (use with treats) GIVE Give whatever is in pet s mouth to human EASY When taking something from human s hand into pet s mouth (easily and softly) FREE/THAT S ALL/GO PLAY Release commands; whatever pet has been told to do, they are now free STOP IT/QUIT IT Whatever pet is doing should be stopped immediately. This command should always be paired with another command the pet knows such as sit, come or down
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PAWSITIVELY PERFECT BOARDING & DAYCARE AGREEMENT. Address: City: State: Zip: Phone: Home: Work: Cell: Text? Y N
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Client Information. Dog Profile
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Daycare / Boarding Application
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Ranger s Pet Outpost and Retreat Service Agreement
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Compassionate Dog Training & Daycare. Daycare
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CANINE SURRENDER PROFILE
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HART Hoopeston Animal Rescue Team
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Pet Personality Profile
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Fri. We will contact you to make an appointment for a private consultation. A. Owner Information. Owner s Name:
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Tug Dogs Canine History Form
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Dog Enrollment Application
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Leadership 101 By Marc Goldberg
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GUEST INFORMATION SHEET. How did you hear about Dogstown University? Relationship: Pet Name: Breed: Color/Markings: Approximate Weight:
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Daycare & Boarding Application
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