Intake Form

NEW CLIENT APPLICATION FORM
Owner Information
Name Of Owner: *

First Name Last Name
Primary Email: *
Cell Phone: *
Home Phone:
Best Time To Be Reached:

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Are you a new client or a current client?

Current Client New Client
Dog Information
Dog's Name: *
Breed: *
Date Of Birth: *
Gender:

Male Intact Male Neutered Female Intact Female Spayed
Weight: *
Where did you get your dog?
How old was your dog when you got them?
Which services are you interested in (Check all that apply): *

Daycare Boarding Grooming Training
If you are interested in daycare, how often do you want to bring your dog? *

Less than once a week 1-2 times a week 3-4 times a week 5 or more times a week I am not interested in bringing my dog to daycare
If you are interested in boarding, how often would you want to board your dog? *

1-3 times a year 4-6 times a year 7-9 times a year 10 or more times a year I am not interested in boarding my dog
If you are interested in grooming, how often would you want to groom your dog? *

1-3 times a year 4-6 times a year 7-9 times a year 10 or more times a year I am not interested in grooming my dog
If you are interested in training, what has your dog already been taught?
How do you currently exercise your dog? (e.g. daily walks, playing with toys, etc.)
Which of the following behaviors does your dog exhibit? (Check all that apply) *

Chewing Nipping Jumping On People Difficult On Leash Mounting Excessive Barking Digging Holes Running Away Steals Objects Does Not Come When Called Eats Poop NOT Housetrained Head Shy Fearful Of Loud Noises Prone to Hot Spots Urinates When Excited/Nervous Attempts to Escape House/Yard Climbs Fences Fearful of Men Eats Foreign Objects Wary of New People Aggressive Towards New People Possessive of Objects Anxious/Upset When Away From Owner None of the Above
Do you use a crate for your dog? *

Yes No
If yes, when do you use it? How does your dog act when in the crate? *
Has your dog ever damaged a crate? *

Yes No
If yes, please explain. *
Is your dog friendly around new people? *

Yes No
What does your dog do that makes you think that? *
Is your dog friendly with new dogs? *

Yes No
What does your dog do that makes you think that? *
Is your dog comfortable with people near them when they are eating? *

Yes No
What does your dog do that makes you think that? *
When your dog is playing with a toy are they friendly? *

Yes No
What does your dog do that makes you think that? *
Is your dog comfortable and relaxed when left alone? *

Yes No
What does your dog do that makes you think that? *
Does your dog have any current or past medical conditions of either a physical or mental nature? *

Yes No
If yes, please list and describe: *
Check All Vaccinations Your Dog Is Currently Up To Date With:

Rabies Distemper Parvo Bordatella, Every Six Months Fecal Test, Every Six Months
How did you hear about us? We like to thank those that refer us! *
Thank you for your interest in WOOF WOOF Daycare & Boarding!

Please take a moment to review our policies and procedures, which can be found on our website

Click Here for Woof Woof Website

A pack leader will call you within 48 hours to review your information, answer your questions, and schedule your dog's first day of daycare on which their evaluation will occur.

We look forward to meeting you and

your dog!
woofwoof.net - (603)-890-6239 - woofwoofdaycare@gmail.com

47 Rockingham Road, Windham, NH 03087
E-mail
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NEW CLIENT APPLICATION FORM

Owner Information

Dog Information