PET OWNERS INFORMATION: Name: Address: City: State:
Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Columbia (District of) Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: CONTACT INFORMATION: How did you hear about us?
Newspaper
Internet
Rescue group
Ritters
Client referral
Other
Client Referal or Other: List all names of those responsible for picking up your dog(s): DOG INFORMATION: Pets Name: Breed: Pets Age: Birth date: Sex:
Male
Female
Spayed/Neutered?
Yes
No
If yes, approximate age If no, when will he/she be spayed/neutered? How long have you had your dog? Where did you get your dog?
Rescue group
Pound/Shelter
Breeder
Other
Has your dog been trained?
Yes
No
If so, where and to what level: Does your dog require more training?
Yes
No
What commands does your dog know? (ex. sit, down...) Does your dog need to be with you or another household member all the time?
Yes
No
Is your dog afraid of loud noises?
Yes
No
Does your dog entertain itself?
Yes
No
Is your dog crate trained?
Yes
No
What is your dogs energy level?
Low
Medium
High
Extreme
Does your dog destroy their toys?
Yes
No
What behavior issues do we need to be aware of: (ex. nipping, pulling leash) A FEW MORE QUESTIONS ABOUT YOUR DOG: Describe your dogs personality: Is your dog food or toy protective? (please explain) Does your dog show any aggression towards people, other dogs, children, or puppies? (please explain) Can or will your dog jump a 6ft fence?
Yes
No
MEDICAL BACKGROUND INFORMATION :Does your dog have any medical problems or need special medication? (if yes, please explain) Has your dog been tested for worms and is he/she free of parasites?
Yes
No
Is your dog on heartworm and flea preventative? (if yes, what brand) List dates of vaccinations & preventatives given and due dates for each. We will either need records from Veterinarian or the paperwork filled out and signed by your Veterinarian. Receipts are also fine. In case of an emergency, are we authorized to transport your dog to a Veterinarian? Preferred Veterinarian/Clinic: Address: Phone: 
We offer pampered grooming
