registration. Owner/Handler * First Name Last Name Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Dog's Name * Age * (In years and months, if known) Gender * Male Female Spayed/Neutered * Yes No Vaccinations * Rabies DHLPP (5-way vaccine for: canine distemper, hepatitis, parvovirus, parainfluenza and bacterial infection leptospirosis) Bordetella Some, but not all None Is your dog licensed? * Yes No Breed * How long have you owned this dog? * (In years and months) Any obedience training? * Yes No Some How did you hear about us? * (Facebook, Instagram, Next Door, Reddit, Web, Referral, etc.) If referred, who can we thank? * (Type N/A if you were not referred to us) Housebroken * Yes No Some Older dog, may have some accidents Does your dog mount people or other dogs? * Yes No Is your dog anxious or exhibit signs of separation anxiety? * Yes No Is your dog overactive? * Yes No Does your dog urinate when excited? * Yes No Is your dog fearful? * Yes No Does your dog jump on people or counters? * Yes No Is your dog aggressive with people or other dogs? * People Dogs Both Does your dog guard food, bones or toys? * Yes No Does your dog have scheduled meals? * Yes No Does your dog bark or whine? * Yes No Is your dog a destructive chewer? * Yes No Is your dog a door dasher? * Yes No Does your dog come when called? * Yes No Does your dog pull on the lead? * Yes No Has your dog bitten a person or another dog? * Yes No Both Does your dog have any health issues? * (Type N/A if this does not apply) Is your dog on any medications? * (Type N/A if this does not apply) Is there anything else you think we should know? * Thank you!
