Boarding / Daycare Assessment Form

Owner

Name*

First Last

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact Info*

Referred By

Dog

Dog's Name

Sex*

Male
Female

Neutered/Spayed*

Neutered
Spayed
Neither

Breed

Age

Physical/Medical

Veterinarian Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your dog on any medications?

Yes
No

Does your dog have medication related side effects?

Yes
No

Does your dog have any allergies (bee stings, food) / medical issues/etc.? Contagious conditions?

Does your dog have any physical issues (limping, joint pain, previously torn ACL, etc.)?

Yes
No

Background

Where/How did you obtain your dog?*

How long have you owned the dog?*

Have you had a dog before?*

Yes
No

Why are you interested in a leash-free environment for your dog?*

Has your dog previously been in a “leash-free” environment? If so, how long ago, and how did he/she fare?

Feeding

What do you feed your dog? How often?*

Does your dog receive treats / people food?*

Yes
No

Home Life

Any recent changes in your home life? New Home? New family members?*

Are there any other pets in the house? What ages?

Are there any other people in the house? Ages?

Is your dog housebroken?*

Yes
No

Is your dog crate trained?*

Yes
No

Where is your dog when you’re not home?*

How long is your dog left alone? Have you noticed any separation anxiety?*

How do your exercise your dog?

How do you reward your dog?

How do you correct your dog?

Has your dog had any formal training?*

Yes
No

Obedience? How Much? How often did they go?

Do they know the 7 Basic commands? Sit, Down, Stay, Come, Heel, Leave It, Off*

Yes
No

Do they walk on a leash?*

Yes
No

Do they have food or cage aggression?*

Yes
No

Behavioral

Has your dog ever exhibited any of the following behaviors? Give any details:

Other behavior(s)*

Please explain

Owner

Dog

Physical/Medical

Background

Feeding

Home Life

Behavioral

Our Address

Hours

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