* Name
* Address
* City
* State
* ZIP
* Home Phone
Work Phone
Cell Phone
Pager
* Email
* Phone
Additional Contact Info
How did you hear about Canine to Five?
* Sex Male Female
* Date of Birth
* Breed
* Color & Markings
* Is your dog housetrained? Yes No
* Is your dog spayed/neutered? Yes No
* Are there multiple dogs in your household? Yes No
* Does your dog bark a lot? Yes No
* Are there children in your household? Yes No
* Is your dog mouthy/bitey? Yes No
* Does your dog eat treats? Yes No
* Is your dog scared of any noises? Yes No
What noises?
* Does your dog take any meds? Yes No
What & what for?
* Does your dog have any allergies? Yes No
* Does your dog have any past or current injuries? Yes No
* Is your dog scared of anything else? Yes No
What?
* Does your dog share toys well with other humans? Other Dogs?
* What kind of toys does your dog play with at home?
* Is there anywhere specific your dog likes to be pet?
* Is there anywhere specific your dog dislikes to be pet?
* Does your dog get along well with other dogs?
* What interaction has your dog had with other dogs?
* Has your dog ever bitten anyone? If so, please describe:
* How is your dog with strangers?
* Does your dog have a "potty" command? If so, what:
* Has your dog ever had any obedience training?
* Does your dog show any destructive behaviors at home?
* Does your dog jump up on you or strangers?
* Has your dog ever jumped or climbed a fence? If so, how high?
* Is your dog aggressive on a leash?
* How does your dog react to puppies? To smaller dogs? To larger dogs?
* Has your dog ever growled at you or anyone else? Please describe circumstances:
* What else would you like us to know about your dog?
I certify that I have read and understand the rules and regulations and accept all the terms, conditions, and statements of this agreement.
Certification of Health and Temperament I Agree *
To ensure the safety and health of all animals and staff at Canine To Five, we require all clients to comply with the following Rules and Regulations. Please read through this document and signify agreement to the terms.
Rules and Regulations I Agree *