Dog Intake FormPlease enable JavaScript in your browser to complete this form.Name *Date *Dog’s Name *Breed *Age/Sex: *Spay/Neut.? *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Referred by *Other Pets in Household *Other People in Household *Occupation/Time spent outside home *Veterinarian *Medical Problems/Meds/Allergies *Date of Last Rabies Vaccination *Expiration *Brand of Food *How many times per day? *What times is dog fed? *Eat right away/finish meals? *Other treats/snacks & how often *Where was dog obtained/How long ago *Housebroken? *Crate trained? *Where does dog sleep? *% time indoor/outdoor? *Where kept when owner gone? *Any previous training? Behaviors dog knows/training methods used/trainer: *Exercise Type/Frequency *Equipment used on walks *Has dog ever bitten or injured a person or animal? ____ (If yes, describe in Notes section) Reason for Consultation: *Message *Submit