New Client Questionnaire

Tikaani-Atka Boarding Kennel

New Client-New Pet Questionnaire

Date: ______________________

Your Name: _____________________________________________________________

Address: ________________________________________________________________

City: ________________ Province: __________________  Country: ________________

Phone: (H) ___________________ (W) _____________________ (C) ______________

Email address: ___________________________________________________________

Emergency Contact Name & Phone Number: ___________________________________

Pet’s Name: ____________________________ 

Breed: _____________________________ Color: _______________________

Sex: Neutered Male  Intact Male  Spayed Female  Intact Female

Veterinarian Name & Clinic: ______________________________________________________

1. Does your pet have any food allergies? If so, please list:

_____________________________________________________________________________

2. Do you have any objections to us giving our pet treats? ______________________________

3. Is your dog on any medications or does she/he have any medical problems that we need to be aware of? Please list and explain: _____________________________________________________________________________

4. How many hours is your pet accustomed to sleeping at night? ________________________  

5. Has your dog ever been socialized with other dogs? Yes No

6. Is your pet house trained? Yes No

7. Is your pet able to jump fences? If so how high? Yes No ______________________________

8. Does your pet have any behavioral problems or issues in any of the     following areas?

 Mouthiness - Yes No 

 Food aggression - Yes No 

 Excessive barking - Yes No

 Separation Anxiety - Yes No 

 Coprophagia (eating poop, own or others) - Yes No 

 Mounting other dogs - Yes No

 Has your pet ever been aggressive or snapped at a person? - Yes No 

 Has your pet ever been aggressive or snapped at another dog? - Yes No 

     Does your pet get along with other dogs, big & small? - Yes no      

 Has your pet ever been socialized with a large group of dogs? - Yes No 

  9. Has your pet been known to chew beds, rugs, toys, etc - Yes No

10. Does your pet like small swimming pools? Yes No

11. Will your pet play fetch? Yes No

12. Does your pet dig? Yes No

13. Does your pet have any physical limitations? Yes No

_____________________________________________________________________________

14. Do you use flea/tick preventative regularly on your pet? Yes No 

15. Is your dog afraid of particular noises? Yes No ____________________________________

16. My pet does not like to be petted here- _________________________________________

17. What commands is your dog familiar with? _____________________________________________________________________________

18. Are we able to post pictures of your pet on Facebook & Twitter? Yes No 

19. Is there anything else we should know about your pet? 

______________________________________________________________

20. Were you referred? If so, by whom? ______________________________________________________________

21. Best e-mail to send pictures_____________________________________

Thank You! 

The information collected above will help us determine how to give your pet the 

best possible care while boarding here at Tikaani-Atka Boarding Kennel. 

We hope your pet enjoys his/her stay!

Client signature: _______________________________  Date: ________­­­­_­­­­­­­­___