Dog and Owner Form

Address *

Dogs Name(s)
Primary Phone Number *

- Area Code Phone Number
Secondary Phone Number

- Area Code Phone Number
E-mail
Spouse's Name:

First Name Last Name
Spouse's Primary Phone #:

- Area Code Phone Number
Spouse's Secondary Phone #:

- Area Code Phone Number
Emergency Contact:

Person's to contact in the event that you or your spouse cannot be reached:
Emergency Contact # 1

First Name Last Name
Emergency Contact Phone #:

- Area Code Phone Number
Preferred Veterinarian for Non-Critical Care:
Veterinarian Name:
Hospital or Practice Name
Vet Phone #
Vet Location
Dog #1 Info:
Dog1 Name: *
Dog1 Breed:
Dog1 Color and Markings:
Dog1 Sex:

Male Female
Dog1 Date of Birth:

Month Day Year
Dog1 Neutered or Spayed? *

Yes No
Does your dog have any health issues that will limit movement or activity? Please Describe:
Medications? include name of medication, dosage and dosing schedule
Dog1 Type and Brand of Food:
Dog1 How much per serving?
Dog1 How Many Servings Per Day?
Is your dog comfortable being crated at night?
Allergies and/or Dietary Restrictions If any:
Do You Have More than 1 Dog? *

Yes No

Dog #2 Info:

Do not complete this section if you have only 1 dog.
Dog2 Name:
Dog2 Breed:
Dog2 Color and Markings:
Dog2 Date of Birth:

Month Day Year
Dog2 Sex:

Male Female
Dog2 Neutered or Spayed? *

Yes No
Dog2 Type and Brand of Food:
Dog2 How much per serving?
Dog2 How Many Servings Per Day?
Medications? include name of medication, dosage and dosing schedule
Does your dog have any health issues that will limit movement or activity? Please Describe:
Is your dog comfortable being crated at night?
Allergies and/or Dietary Restrictions If any:

Dog and Owner Info