Planet Pooch

About You
Name(s):
 
Address:
City:
Zip:

Please enter full phone number(s), area code first.
Home Phone: 
Work Phone:
Cell Phone:
Preferred phone number
for Planet Pooch name tag: 
E-mail:
Preferred Location: 

About Your Pooch
Name: (please fill out a separate application for each dog)
Sex: Male   Female
Age:
Birthday:
Breed(s): (if your dog is a mix, please try your best to guess the breeds)
Color(s):
Veterinary Clinic:
Clinic's Address:
Clinic's Phone:


Current Vaccinations (dates last given)
DHLPP:
Rabies:
Bordatella:

Questions
What form of flea control do you use?

At what age was your dog spayed or neutered? (Male dogs must be neutered before
12 months of age and all female dogs must be spayed regardless of age).
How long have you owned your dog?

Where did you get your dog?

If adopted, what do you know of your dog's past history?

What other pets are in your household?

How does your dog interact with the other pets in your home?

How does your dog react to children?

How does your dog react to puppies?

How does your dog react to dogs a great deal smaller than him/her?

How does your dog react to dogs a great deal larger than him/her?

Are there any types (i.e., large, furry) or breeds of dog that your dog
fears or dislikes?

Do visitors ever bring their dogs to your home? If yes, how does your
dog react?

Has your dog ever growled or otherwise acted in a menacing manner
toward anyone approaching you, your home, yard or car? If yes,
please explain.

Are there any kinds of people your dog tends to dislike (i.e.. gender,
personality type, etc.)? If yes, please explain.

Has your dog ever bitten someone? If yes, please explain.

Does your dog have any medical problems? If yes, what restrictions
need to be placed on your dog's activities?

Is your dog on any routine medications? If yes, what and how often?

Have you ever tried to take food away from your dog? What happened?

How does your dog respond if you or another dog takes away a toy
that he/she is playing with?

Does your dog ever play off-leash with other dogs? If so, what types/
breeds?

Does your dog have a preference for male or female dogs? If so, which?

Has your dog had any formal obedience training? If so, when and where?

How do you correct and/or discipline your dog?

Is there anything else we should know about your dog?

What services do you seek from Planet Pooch? (select all that apply)
     Daycare
    Boarding
    Grooming
    Obedience classes
    Behavior consultation

How did you hear about Planet Pooch?

Genentech Employee
  Please click here if you are currently an employee of Genentech.

Google Employee
  Please click here if you are currently an employee of Google.

Policies
I agree that I have read and agree to Planet Pooch's policies and requirements.