Dog Intake Record Checklist
Complete this checklist to record all essential information when admitting a new dog.
Dog's Name
*
Breed
*
Sex
*
Male
Female
Unknown
Estimated Age (years)
*
Date of Intake
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Microchip Status
*
Present and scanned
Not present
Unknown
Vaccinations Received
Rabies
Distemper
Parvovirus
Bordetella
Other
Health Check Completed?
*
Yes
No
Special Notes or Observations
Submit Checklist
Should be Empty: