Emergency Contact #1
Emergency Contact #2
Others authorized to pick up my pet:
Name of Veterinarian:
Breed (If a mix, list 2 predominant breeds in behavior):
Spay/Neuter Date (All dogs over six months of age must be spayed or neutered to attend our daycare/boarding programs):
Where did you get your dog?
Why are you considering Dogwood's Program?
Which of the following best describes your dog's level of socialization with other dogs: None - no knowledge of other dog interactionMinimal - on-leash encounters onlyModerate - some off-leash playtime on occasion with visitor's/neighbor's/friend's dogExtensive - regular visits to dog social events, off-leash dog parks, dog daycare, etc.
Has your dog had any problems previously in an off-leash social environment? YesNo
If Yes, check all that apply:
Altercation or fight at public dog parkAltercation or fight with a neighbor's or friend's dogFearful reaction in a group of dogsDismissed from a prior dog daycare or social playgroup programOther
If "Other" please describe:
Only complete if you answered yes above, that your dog was dismissed from a prior program:
What reason were you given as to why your dog was dismissed?
Please describe your dog's flea/tick prevention program:
Does your dog have any allergies? YesNo
If Yes please describe:
Does your dog have any physical disabilities? YesNo
Please explain disability and cause, restrictions needed, medical conditions and/or meds:
Provide details of your dog's diet:
a. type (kibble, canned, raw/natural)
b. brand (Innova, Iams, Purina, etc.)
c. feeding schedule:
On what type of surface does your dog generally go to the bathroom (e.g. grass, mulch, pee pads)?
Does your dog have any bathroom related issues or concerns? YesNo
If yes, please explain:
How does your dog react to have his/her nails clipped?
Does your dog like to be brushed? YesNo
If no, what have you tried to make it more enjoyable?
Does your dog have any sensitive areas on his/her body? YesNo
If yes, where?
Where are your dog's favorite petting spots?
How frequently is your dog walked outside?
How long are your walks?
Check the box below that best represents your dog's overall level of exercise routine: Couch Potato: Spends days sleeping, occasional walks and/or playtime with humans or other dogsMild Exerciser:Short daily walks and/or regular playtime with humans or other dogsModerate Exerciser: Long or multiple walks daily and regular playtime with humans or dogsAthlete: Regular jogs/runs and/or regular participation in a dog sport activity such as agility, flyball, frisbee, etc.
Do any visitors bring their dogs to your house? YesNo
If yes, how do they get along?
Are there any types and/or breeds of dogs your dog seems to automatically fear or dislike? YesNo
If yes, please explain
How does your dog react to puppies?
How does your dog react to another dog approaching him/her in a park, at the beach or on a walk?
Does your dog play with other dogs? YesNo
If yes, Which type:
Males and females, only males, only females
Please describe size, breed and temperament of the other dogs:
Has your dog ever shared his/her food or toys with other animals? YesNo
If yes, how does your dog react to another dog approaching his/her food or toys?
Which commands does your dog know? (check all that apply)
If "Other" please explain:
How did your dog get his/her obedience training? (check all that apply) Attended one group classAttended more than one level of group classes (beginner, intermediate, etc)Dog was sent to a board and train programPrivate sessions in homeNo formal trainingOther
Which of the following best describes the use of obedience training cues with your dog at home? Key part of daily communicationUsed when we go on walks or have people overUsed occasionally to better control behaviorRarely usedNot applicable
What kind of collar do you use to walk your dog? BuckleNylon/Chain Choke CollarHarness leash clips on backHarness - leash clips on frontHead CollarProng/PinchOther
Is it effective keeping him/her under control? YesNo
Has your dog ever gotten away from someone when out for a walk? YesNo
If yes, please explain circumstances:
Where does your dog sleep? Inside the houseOutside the houseInside/Outside varies
In which room in the house does your dog sleep?
Where in the room does the dog sleep? CrateOwner's BedDog Cushion/Bed on FloorOther
What does your dog do to show he/she is happy?
What does your dog do to show he/she is upset?
Does your dog have any problems in the following areas?
House training YesNo
Ignoring Commands YesNo
If yes, please explain.
Are there any types of people your dog seems to automatically fear or dislike? Explain
Has your dog ever growled at someone? If yes, what were the circumstances and how did you respond?
Has your dog ever bitten a person? YesNo
If yes, what were the circumstances and how did you respond?
Please describe any injuries.
To the best of your knowledge, what does your dog do when you're not at home?
Has your dog ever climbed/jumped a fence? YesNo
If yes, what were the circumstances? How high was the fence?
Has your dog ever escaped from your house or yard? YesNo
If yes, please explain the circumstances:
Has your dog ever chased or tried to chase a small animal? YesNo
If yes, what were the circumstances?
Is your dog frightened of thunderstorms? YesNo
If yes, describe typical behavior and what specifically helps relax your dog or calm his/her behavior?
Is your dog frightened or nervous around anything else? YesNo
Other comments or information about your dog you feel may be helpful: