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BED AND BISCUITS NEW CUSTOMER FORM
Please fill out and submit this online new customer form.
How did you hear about us?
*
Animal Services
Dog Park/Beach
Drive By
Event
Facebook
Flyer
Friend Referral
Internet Search
SPCA
Vet
Yelp
Yellow Pages (the paper kind)
Other
If referred by a friend please let us know who so that we may thank them.
OWNER INFORMATION
1st owners first name
*
1st owners last name
*
Home Phone
Cell Phone
Work Phone
Email
2nd Owners First Name
2nd Owners Last Name
Home Phone
Cell Phone
Work Phone
Email
Street Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
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
Washington DC
Zip Code
*
List other contacts if we are unable to reach you.
Name
Phone Number
Authorized to pick up?
Yes
No
Authorized to make health decisions?
Yes
No
Name
Phone Number
Authorized to pick up?
Yes
No
Authorized to make health decisions?
Yes
No
Name
Phone Number
Authorized to pick up?
Yes
No
Authorized to make health decisions?
Yes
No
PET INFORMATION
Pet 1
*
Dog
Cat
Pet # 1 Name
*
Pet # 1 Color
*
Pet 1
*
Male
Female
Pet 1
Spayed or
Neutered
*
No
Yes
Pet 1 Breed
*
Pet 1 Weight
*
Pet 1
Date of Birth
*
+
Vet Clinic
Vet Telephone Number
Does your dog or cat have any allergies or diet restrictions?
*
No
Yes (please explain)
Yes (please explain)
Does your dog or cat have any medical needs we should know about (such as medications, injuries, prior health conditions, etc.?
*
No
Yes (Please Explain)
Yes (Please Explain)
Does your dog or cat cough, wheeze, or exhibit any asmatic symptoms?
*
No
Yes
Has your dog or cat ever stayed at a pet care center?
*
No
Yes
Answer only if this pet is a dog.
Does your dog (pet #1) like playing with other dogs? A yes answer means your dog can be assigned to a play group monitored by a staff member (as long as neutered if male and not in heat if female). If no your dog will have one on one time with a staff member during daycare or boarding.
No
Yes
How long have you had pet #1?
Where did you acquire pet #1?
What obedience cues does your pet #1 know (e.g. sit, down, come, stay, etc?)
How did your pet #1 acquire his/her training(e.g. group classes, multiple classes, board/train, etc.)?
Out of the following options, which would you say best describes your obedience practice with pet #1?
A key part of daily communication
When out on walks
Rarely used
Not applicable
Would you be interested in finding out more about our Lodge and Learn or Doggie Day School Training programs? If yes please indicate if you prefer we contact you by phone or email.
No
Yes
Yes
How is pet #1 with meeting new people?
Out of the following options, which would you say most describes your pet#1?
Exuberant
Shy
Friendly
Grumpy
Has pet #1 ever bitten a person or another dog?
No
Yes (Please Explain)
Yes (Please Explain)
Has pet #1 ever been bitten or attacked by another dog, or been abused?
No
Yes (Please Explain)
Yes (Please Explain)
Is pet #1 a jumper, climber, or escape artist?
No
Yes (Please Explain)
Yes (Please Explain)
Answer for all pets.
Is there anything else you feel we should know about pet #1?
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