New Customer Form

Please fill out the form below, submitting one form for each dog in your family. All fields are required.
If submitting this form on a weekend, please allow extra time for processing.  We will enter your
information into our database and contact you as soon as possible to set up an evaluation day for your pet(s).

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OWNER & DOG INFORMATION
Owner's First Name
Owner's Last Name
Dog's Name
Breed (or best guess)
Weight
Sex	Male   Female	Spayed/Neutered? Yes    No Dogs must be spayed/neutered if over the age of 6 months. (only applies to boarding/daycare dogs)
Color/Description
DOB (if unsure, please estimate):	(MM/DD/YYYY)
Vet/Clinic Name
Vet/Clinic Phone Number
What type of service are you interested in?	Boarding   Training   Daycare   Board & Train Charm School   Massage   Chiropractic
CONTACT INFORMATION
Home Address
City
State
Zip Code
Home Phone
Work Phone
Cellular Phone
Email Address
What is your preferred method of contact?	--Select One-- Home Phone Work Phone Cell Phone Email
Alternate Contact Person's Name
Alternate Phone Number(s)
Emergency Contact Name (Other Than Self)
Emergency Contact Phone
How did you hear about DogBoy's?	--Select One-- Vet Rescue Group Local Event Website/Internet Search Friend/Dog Boy's Customer DogBoy's Employee Other Kennel/Trainer Other Please specify:
GENERAL INFORMATION ABOUT YOUR DOG
How old was your dog when you got him/her? (if unsure, please estimate)
How and/or where did you get your dog?
Is your dog a (check all that apply):	Digger   Fence Climber Fence Jumper If fence jumper or climber, list type of fence and height
Is your dog sound or sight sensitive (check all that apply):	Thunderstorm   Lightening   Firecrackers Other
How do you socialize your dog (check all that apply):	Friends/Family Dogs  Dog Park  Housemates Only People Only Other  None
Is your dog (check all that apply):	Dog Aggressive     Human Aggressive Please explain:
Has your dog ever bitten anyone?	Dog   Adult   Child
Did he/she break skin?	Yes    No Please explain:
Favorite Games w/Family/Owner (check all that apply):	Tug   Fetch   Chase   Wrestle   Hide & Seek   Walks
Where does your dog sleep? (check all that apply):	Owner's Bed   Owner's Bedroom Child's Bedroom   Other Room In House Outside   Other
How does dog react to crate?	Love   Tolerate   Hate   Destroy   Unknown
(If multiple dogs) Can your dogs board in the same room together?	Yes    No Comment:
On a scale of 1-5, how easy is it to groom your dog?
Bath	Easy ----------------------------------Difficult 1     2     3     4     5
Nails	Easy ----------------------------------Difficult 1     2     3     4     5
Has you dog ever needed to be muzzled for grooming?	Yes    No
What BRAND of dog food do you feed (main meals)?
Check feeding habits:	Free feed   Three times a day   Twice a day   Once a day
Does your dog have any allergies?	Yes    No If yes, specify:
Is your dog taking any medications?	Yes    No If yes, specify:
Is your dog currently on flea preventative?	Yes    No What Kind:
Is your dog currently on heartworm preventative?	Yes    No What Kind:
Has your dog ever had seizures?	Yes    No First Last Medications
Please list behavior problems your dog exhibits:
Please list goals for your dog:
Special Instructions
I have read and agree to the Rules of the Game (By selecting the check box above, you are giving your online signature that the statement is true and correct) Today's Date (MM/DD/YYYY)