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:
- Biting (people, other dogs)
- Dominance/Mounting
- Open gates/latches
- Hyperexcitability– how do you calm him/her?
- Barking
- Jumping / climbing fences
- Fear (noises, people, dogs, etc.)
- Aggression/raging (handling, people, dogs)
- Digging/scratching
- Marking
- Resource guarding (food, toys)
- Other
Other behavior(s)*
Please explain

Boarding / Daycare Assessment Form

Owner

Dog

Physical/Medical

Background

Feeding

Home Life

Behavioral

Our Address

Hours

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