Customer Information Sheet
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- Katrina Stafford
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1 How did you hear about Happy Dogs? Customer Information Sheet Your Name: Address: City State: Zip Home Phone: Work Phone: Cell: Address: If we can't get in touch with you who can we call? Contact: Name: Address: City State: Zip Home Phone: Work Phone: Cell: Veterinarian: Name: Address: City State: Zip Phone: About your dog: Name: Sex: M / F Spayed/Neutered Y / N Age: Birthday: Breed: Color: Weight: Micro Chip Y/N # Feeding Schedule: Brand and Type of Food:
2 Is your dog allowed to have treats? Y / N Where did you get this dog? How long have you had him/her? If you have not had him/her from puppy hood, what do you know of its prior history? Are there any other animals in the household? (Species/ Breed/ Age) What is the make up of your household? Adult Males Adult Females Children/Ages Which family member is your dog most fond of? Which sex is your dog most fond of M / F? Please describe your dogs overall temperament: How does your dog react to other dogs? (Generally) Has your dog ever participated in play at a dog park? Y / N If yes, how did he/she react with the other dogs? How does your dog react to strangers? Does your dog have any kinds of people he/she automatically fears or dislikes? Y / N Does your dog have any kinds of dog that he/she automatically fears or dislikes? Y / N Has your dog ever bitten someone? Y / N Has your dog ever been in a fight or bitten another dog? Y / N
3 Has your dog ever escaped or attempted to escape by digging/jumping or climbing fences? Y / N Does your dog jump on people? Y / N Do you walk your dog? Y / N How often? Distance What other exercise does your dog receive? How often? What know behavioral problems does your dog have? Does your dog have a circumstance or situation that he/she is frightened of Y / N Describe how you would calm the dog during this situation: Is your dog housebroken or crate trained? Y / N Does your dog play with toys? Y / N What kind? Is your dog toy possessive? Y / N Has your dog shared toys/food/water with other dogs before? Y / N Where there any problems? Has your dog ever played on playground or agility equipment before? Y / N Do you feel that play equipment would be inappropriate for your dog? Y / N Does your dog prefer a particular sex of dog? Has your dog ever received any formal training? Y / N Where and When? Does your dog know any commands? Y / N
4 What special commands does your dog know? Bathroom Command: Quiet Command: Play Command: What do you do with him/her when you leave the home? How does he/she react when you get home? Does your dog have any health concerns that you are aware of? Y / N Does your dog have any medical restriction son his/her activities? Y / N Is your dog currently on any medication? Y / N Does your dog have any allergies? Y / N Does your dog like to receive brushings? Y / N How often is he/she brushed? How does your dog react to getting his/her nails clipped? Does your dog have any areas on his/her body that he/she does not like to be touched? Y/ N Does your dog have a special place that he/she likes to be petted or rubbed? Y / N Does your dog receive flea and tick preventative? Y / N Brand: Type: Frequency: Is there anything else that you believe we should know about your dog? When would you like to start?
5 Medical Release Form Your Name: Dogs Name: Age: Breed: This is a required form for all Happy Dogs participants receiving services. First and foremost the safety and well being of your dog(s) is of the highest importance. Insuring that your pet remains safe and well cared for is our first responsibility and as such we take it very seriously. We do our best to have our pet parents screen for preexisting health conditions but some factors may be beyond our control. In the event that a medical emergency arises while a pet is at our facility or participating in a service that we provide, it is imperative that we are immediately able get them medical treatment at the closest available facility. We will call ahead to the veterinary offices in closest proximity geographically to us to insure they can handle the emergency present. Your dog will be rushed to the closest available facility for treatment and you will be notified. We notify the owner after we have secured a medical treatment center for the animal to avoid delays that may be caused by emotion on the part of the owner. Our goal is to get your pet medical attention as quickly as humanly possible, and any distractions may interfere with that process. For that reason it is a requirement to have our pet parents sign this form. I understand that in the event of a medical emergency that Happy Dogs, at its sole discretion, may deem the need of immediate attention of a licensed veterinarian. I Authorize Happy Dogs to seek medical attention at the closest available veterinary facility. I further agree that I am financially responsible for any medical treatment my Dog(s) receives as a result of a medical emergency while attending services provided by Happy Dogs. Signature of Owner: Date: Printed Name:
6 Dog Care Agreement Your Name: Address: City: State: Zip Home Phone: Work Phone: Cell: Dogs Name: Age: Breed: 1. I understand that Happy Dogs has relied on my representation that my dog is in good health and has not injured or shown aggression of threatening behavior to any person or dog in admitting my dog for services at their facility. 2. I further understand that Happy Dogs, their owners, staff, partners and volunteers will not be liable financially or otherwise for injuries to my dog, me or any property of mine while my dog is participating in services provided by Happy Dogs. I hereby release Happy Dogs of any liability of any kind arising from my dog s participation in any and all services provided by Happy Dogs. 3. I further understand and agree that any problems with my dog s behavioral, medical or otherwise will be treated as deemed best by the staff of Happy Dogs in their sole discretion, and in what they view as the best interest of the dog. I understand that I assume full financial responsibility and all liability for any and all expenses involved in regards to the behavior and health of my dog. 4. I further understand that there are risks and benefits associated with group socialization of dogs. I agree that the benefits outweigh the risks and that I accept the risks. I desire a socialized environment for my dog while attending services provided by Happy Dogs and while in their care. I understand that while the socialization and play is closely and carefully monitored by Happy Dogs staff to prevent injury, it is still possible that during the course of normal play my dog may receive minor nicks and scratches from roughhousing with other dogs. Any injuries to my dog will be pointed out by staff upon pickup. 5. I understand by allowing my dog to participate in services offered by Happy Dogs, I hereby agree to allow Happy Dogs to take photographs or use images of my dog in print or otherwise for publication and/or promotion. 6. I further understand that I am solely responsible financially or otherwise for any harm or damage caused by my dog while he/she is attending any services provided by Happy Dogs. 7. I understand that if my dog is not picked up on time or by a date specified in a separate agreement, I hereby authorize Happy Dogs to take whatever action is necessary for the continuing care of my dog. I will pay Happy Dogs the case of any such continuing care upon demand by Happy Dogs. I understand that if I do not pick up my dog, Happy Dogs will proceed according to the guidelines provided by Georgia Statue abandonment of animals by owner. I also acknowledge that I will be fully responsible for all attorneys fees and associated costs if I abandon my dog. Signature of Owner: Date: Printed Name:
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