COUNTRY HOME PET RETREAT, LLC

Tell us about your pet (If you have more than one pet, please fill out a separate form for each of them).

Client Name *

Pet Information:

Pets Name: *

Species: *

Breed: *

Birth date/ approximate age: *

Male or Female? *

Are they altered? *

Color: *

Weight: *

What brand of pet food do you feed and any specific flavor/type (beef, chicken, lamb, etc.)? *

When is your pet normally fed? *

How much do they eat at each meal? If you use anything other than a regular 8oz. measuring cup, please provide your scoop, or pre-package individual meals. *

Do they take any medications? If so, please list medication name, dosage and frequency, as well as if you have any special instructions for administering them to your pet. We usually use cheese. *

How long has your pet been in your family? *

Does your pet get along with other animals? *

Has your pet ever bitten, attacked and/or shown aggressive behavior towards any other animal? *

Has your pet ever bitten, attacked and/or shown aggressive behavior towards other people or strangers? *

Does your pet growl or snap when food or toys are taken away or shared by other animals? *

Does your pet growl or snap for any other reason? *

How does your pet behave at a daycare / boarding facility? *

How does your pet behave in public? *

Has your pet ever climbed, jumped or dug out of fence? *

Has your pet ever darted out a door or gate? *

Where does your pet normally sleep at night? *

What do you normally do when you leave the house and pet(s) are left alone unsupervised and unattended? *

Please describe any behavioral problems you might know of: *

Is there anything else we should be aware of? *

May we provide your pet treats, chews, kongs, etc., or only provide the treat/chew items you provide? *

Tell us about your pet’s health:

Animal Hospital: *

Veterinarian: *

Phone *

Address *

City *

State *

Postal code *

List any allergies: *

Describe any medical conditions: *

Is your pet on a regular flea preventative? *

Vaccinations: Please email a copy of your dog’s current vaccination records from your vet to info@countryhomepetretreat.com . Required vaccinations: Rabies.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

417-607-6885

info@countryhomepetretreat.com

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