INTAKE_FORM by shuifanglj


									                                             “POKEE’S PLACE”

   * 360-642-2944 * *
                                   ~ ABOUT YOU — Our “DOGGIE PARENT” ~

         Email: ___________________________________________________________________________
         Address & City/State/Zip: ____________________________________________________________
         Home Phone:___________________________ Cell Phone #1:______________________________
         Cell #2, office, family, or friend phone (Who?) ______________________________________________________
  How did you
  hear about us? ________________ ______________________ _________________________________            __________________
                 Veterinarian’s Office Internet (how—where?) Recommendation—whom can we thank?        Pet Store (which one?)

                                              ~ ABOUT YOUR DOG ~
                                                    Page 1
                                   The more we know about your dog, the better!

__________________ ________________ _____________ ____ _____                             Y_____ N_____      Y____ N____
 NAME                      BREED                   Color/s              Sex      Age    Spayed/Neutered?     Micro-chipped?

  MEDICATION ALERT: If your pet is on medication, please be specific with medication name, all details
                     with dosing information, etc., on reverse side.

Tell us everything we should know about your dog. Whether a day care dog or an overnight—vacation guest, we want
your dog to feel comfy and at home here. Therefore, in order to provide the best possible care, the more we know about
them, the better. A long narrative is great. Please continue on back side or attach a separate sheet if necessary.

   Daytime routine: Activity level: Will they run & explore outdoors with other dogs; chase, fetch; play ball and Frisbee?
   Is s/he a “water dog” who will enjoy water sports with the others in the pond? Perhaps your dog prefers to be indoors
   more — take naps and hang out with people and smaller dogs? Many are a little of both. Please let us know what to
   expect of your dog’s daytime routine and preferred activities:
   Night time habits: Where does your dog sleep at home? Do they use a bed, a blanket, or a crate? We want you to
   bring their sleeping gear for their overnight stays to create maximum comfort and familiarity. Wherever they sleep at
   home is where we want them to sleep here, too. About what time is “last p-call “ outside before bed? Anything
   special we should know about their night time routine?
                                                                                                  ~ continued on next page ~
                                       ~ ABOUT YOUR DOG ~
                                             Page 2
 This form continues a get-to-know-doggie narrative for _____________________ _________________
Temperament & General Behavior: Is your dog well socialized & play well with others? Is s/he hyperactive
at times? Any “alpha-dog” tendencies we should be aware of? How about “less than wonderful” habits we
should be aware of, such as: jumping on people to say hello; refusing to come when called; pizzling in the
house on occasion; chewing on things other than dog toys? Being aware of possible bad behaviors is better
than not! Important: If your dog has ever been involved in biting a person or another dog, please tell us
when and details of the incident on back side of this sheet.
Training & Commands: (a) Will your dog readily come when called? (b) Do they respond to basic “sit” &
“stay” commands? (c) Are there other commands they know & will respond to? (d) Has your dog had any
formal training? (e) any training or commands we can continue as part of their daily activity time here?

Daily Feeding (& Treat) Instructions: Although you supply your dog’s usual and customary food and treats
for their stay, (a) what is the preferred brand of dog food? (b) What time and how much are they to be fed?
(c ) Is it okay that your dog enjoy a variety of treats from our treat bin — or should they stick to their own?
(a) _____________________________________________________________________________________
            If there is anything else we should know, please continue on back side.


______________________________________________________ _____________________
CLINIC and VET NAME                    City             (A/C) & Phone

         I authorize my pet sitter and you, a licensed Veterinarian, to treat my pet
       for any medical emergency or treatment that my arise in my absence.
         I agree to pay for any services deemed necessary upon my return.

______________________________________                        _______________________________
 Your Signature                                                 Date
                                                             Please remove this page and keep for your records

                                     OVERNIGHT (“Vacation”) DOGS
                 Whether your dog’s overnight stay is for a weekend or a week,
                                    please bring the following for them:
      Their customary food and preferred treats — please mark their name on food items *Their food bowl
                  *Bed or favorite blanket *Collar with ID *Medication and instructions, if any
                           *A stuffed toy, Kong, or tough & hearty chews — optional.

We have a never-ending supply of toys, yet your dog may feel more at home with a familiar one. For this reason,
 we encourage it. However, since toys of all shapes have been known to be carted off and disappear out in the
yard … not to be seen again until our annual spring clean up, sending toys is optional. If you do send something,
  ensure they are not special ones; just something familiar. If your dog is a chewer/destroyer, please disregard
    “optional” and send along an appropriate supply of tough & long-lasting chewies of some sort. Thanks!!

                                              DAY CARE DOGS
     Please ensure they wear their collar with their ID attached. In addition, a supply of your dog’s favorite
          treats is welcomed. “Treat time” is customary around here two or three times a day, and we
                            appreciate your contribution to this daily doggie routine.

   (1) Please provide copies of your pet’s VACCINATION RECORDS when you return this form. All dogs who
       stay with us must be up to date on their annual vaccinations. This is a NO EXCEPTIONS POLICY.

   (2) To keep all dogs who stay together healthy & happy, we also require that your dog be current on their
       annual dose of BORDETELLA, either by shot or intra-nasal spray. Bordetella (kennel cough) is now
       commonly given with annual vaccinations, but please . . . check your records. Bordetella takes seven
       days to become effective, so please plan ahead.

   (3) A monthly application of FLEA CONTROL is not only essential, but also required of all of our visitors.
       Year around “environmental” fleas are an issue on the peninsula, making it vital that you faithfully keep
       your dog up-to-date with their monthly flea control.

   (4) Finally, thank you in advance for agreeing to pay for any DAMAGES your dog might do during their stay.
       They are rare — but they do happen. *WOOF* We appreciate your cooperation.

                                      ~ While You’re Away ~
                We’ll care for your dog just like our own, just like you would want!
       Feel free to call or email us and check on them if you like, as we understand being
                  away from your baby. Our preferred phone hours are 9a to 7p.
                                 No worries … Have a great trip!

                                                 POKEE’S PLACE
                                            360 642-2944

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