Jeanette Briggs

Pawsitive Love Intake Date :

New Dog Intake Form - COMPLIMENTARY

General
Owner’s Name: Phone Number:

Address:

Email Address:

Preferred Contact Method: Text Phone Email

Dog’s Name: Dog’s Gender:

Dog’s Breed(s) Dog’s Weight:

Dog’s Date of Birth: Dog’s Age:

Dog’s Color: Neutered Spayed

How long have you had your dog? months years

Do you have any other pets at home?

If yes, describe:

Medical History
Veterinarian’s Name:

Phone Number: Date of Last Vet Visit:

List any known:

Allergies:

Medications:
Medical conditions:

Surgeries:

Medical concerns:

How often do you brush your dog’s teeth?

How often do you take your dog to get a teeth cleaning?

Environment
Does your dog have free access to the house when you leave?

If no, describe:

Do you take your dog to the dog park?

Does your dog attend doggie care?

Does your dog walk with a dog walker?

Where does your dog stay when you go on vacation?

Does your dog run unsupervised outdoors?

Diet
What kind of water does he/she drink?

How much water does he/she drink?

What brand of food does he/she eat?

Dry Wet Both Free Feeding

Number of Meals: Time(s) of Meals

Location of food bowl(s)

List your dog’s favorite treat(s):

How often do you give your dog treats?

Exercise
How often do you take your dog for a walk?

What time(s) of the day?

How do you play with your dog?

Behavior
Select all that apply:

Reluctant to be touched Depressed Distant

Refusal to connect Withdrawn Distracted

Ignores command Sad Extremely noisy

Quieter than usual Aggressive Dejected

Overly possessive Dominating Overly emotional

Lacks enthusiasm Boundary issues Greedy

Excessively fearful Underweight Sluggish

Restless Unwilling to interact with other animals

Excessive whining for no reason Strong fight or flight response

Jealous around other animals for no known reason

Nervous around other animals for no known reason

Thank You!
Peace & Love