(You will receive a copy of this form via email)

Client Information

*Your Full Name:

*Email:

*Main Phone:

Okay to send texts to main phone? No textingText onlyText and picturesText, pictures, and video

Second Full Name:

Second Email:

Second Phone:

Okay to send texts to additional phone? No textingText onlyText and picturesText, pictures, and video

*Your Address:

*Emergency Contact Information (someone who is not traveling with you):

Dog Information

*Dog Name:

*Breed/Description:

*Sex/Reproductive Status: female, spayedfemale, intactmale, neuteredmake, intact

*Birthdate / Current Age:

Microchipped? YesNo
If yes, please list where the microchip is registered and microchip number:

Feeding:

*Please list type of food you will be providing and feeding schedule:

Does your dog have any food sensitivities/allergies? YesNoUnknown
If yes, please list:

In the event that your return is unexpectedly delayed and we run out of food for your dog, please list what type of food could be purchased at "All The Best Pet Care in Edmonds" that would be suitable:

Please check all that you dog is permitted for treats:
BananasBlueberriesAppleCarrotsPeanut ButterReal Meat Turkey and VenisonOnly Treats Provided By Client

*How many times a day does your dog typically poop and when:

Medical Information:

*Please list all your dog's medical conditions:

Is your dog taking any medications or supplements?YesNo
If yes, please name, dosage, frequency:

*Preferred Veterinarian Name/Address: *Phone:

Second Choice Veterinarian Name/Address: Phone:

Has your dog ever had experience with anesthesia? If yes, please detail:

In the event of an emergency, the closest 24 hr vet to my house is Veterinary Specialty Center of Seattle https://www.vscofseattle.com/ - do you authorize me to take your dog there and if yes, please specify dollar amount you would pre-authorize if I cannot reach you for direct authorization:

Household Activities:

*Normal nighttime sleeping arrangements:

*What time of night does your dog usually go to bed:

*Does your dog typically have to potty during the middle of the night, and if yes, what general time?:

*What time in the morning does your dog usually wake up:

*If your dog has verbal cues to urinate or defecate, what are they?

*If your dog has verbal cues to go into their crate or their bed, what are they?

*If your dog has verbal cues that you use when you are leaving, what are they?

*When you leave your dog alone in your home is she/he:
In a crateConfined to one roomHas the run of the whole house

When left alone, has your dog displayed any tendency towards separation anxiety (barking, property damage, etc)? If yes, please describe:

Please list your dog's favorite activities that can be done indoors or in a yard:

Please any activities that you do NOT want done with your dog:

Is your dog allowed up on: my couchmy bedmy lapn/a

If I leave your dog alone in my laundry room for 2 hours would you prefer:
doggie door is accessibledoggie door is lockeddon't care about doggie door

Please list any phobias your dog has (ex: buses, thunder, smoke detector beeps, hats, sunglasses, fireworks, vacuums, children, men, washing machines or dryers, lawnmowers, leafblowers, brooms)

I am home and your dog is in my backyard, what are your preferences? Is dog:
Okay to leave unattendedOkay to leave unattended for a few minutesUnder observation all timesOn leash

Anything else I should know to make your dog's stay as comfortable as possible?