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Please print out form to fax, email or bring with you. Thank You! |
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Name:____________________________________________________________________________________________________________________________ Address:_____________________________________________________________City:________________________________St:__________Zip:__________ Home Phone:________________________________________________Cell:___________________________________________________________________ Work Phone:________________________________________________E-mail:_________________________________________________________________ Emergency contact:__________________________________________Phone:__________________________________________________________________ Vet Clinic:____________________________________Phone:________________________________________________________________________________ How did you hear about us? Phone book vet friend newspaper ad
Name:___________________________________________________ Nickname:_____________________________________________________________ Breed:___________________________________________________ Color:________________________________________________________________ Sex: M Neutered/ F Spayed Age:_______________Birthdate:______________________________________________________________________________
__________________________________________________________________________________________________________________________________ Medications:_____________________________________________________ Reason for use:__________________________________________________ Dosage and times per day:____________________________________________________________________________________________________________ Flea and Tick control (this is highly recommended):________________________________________________________________________________________ Amount of food and times per day:________________________________________________________ Brand of food: ______________________________ Has your dog visited another day care, kennel, dog park, if so how do they react? How is your dog with children?_________________________________________________________________________________________________________ How is your dog with other dogs?_______________________________________________________________________________________________________ Is your dog food or toy possessive? (growl, nip):___________________________________________________________________________________________ Is your dog sight or sound sensitive?____________________________________________________________________________________________________ Is your dog an escape artist? (climb fences, squeeze out of things):___________________________________________________________________________
Please provide any other information that you think will be helpful:____________________________________________________________________________
Remember to please bring a copy of current vaccinations: Rabies, DHLPP, Bordatella
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Crawfish Corners LLC t N4936 Popp Rd t Jefferson, WI 53549 t (920) 674-5517 |