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608-423-7997
perfect10boarding@hotmail.com
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Perfect 10 Boarding LLC
Perfect 10 Boarding LLC serving the southern Wisconsin area
Dog Boarding
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Questionnaire
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Dog Boarding
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Questionnaire
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Questionnaire
Please fill out one questionnaire per dog. You can also download our form and print.
General Dog & Owner Information
One dog per questionnaire
Pets Name
Breed
DOB
Nickname pet responds to:
Spayed/Neutered
Yes
No
(If no, private play time is required)
Where did you obtain your pet from? Is it a rescue?
How long have you owned your pet?
Vet Clinic
Vet phone number
Owner's Name
First
Last
Owner's phone number(s)
Emergency Contact
First
Last
Emergency contact phone number
How did you hear about Perfect 10 Boarding?
Feeding, Medications, & Health History
Food Brand
Amount fed at each meal
Other feeding instructions:
Food/Medication Allergies:
List any medications your pet will need
How should these medications be administered? How often?
Has this dog ever been diagnosed or treated for any of the following by a veterinarian? (Check all that apply)
Heart-worm disease
Lyme disease
Heart murmur
Tumors
Epilepsy/Seizures
Skin allergies
Thyroid disease
Arthritis
Irritable bowel
Hip Dysplasia
Separation anxiety
Cancer
Sensitive Stomach
Chronic eye/ear infections
Environmental allergies
Play Yard Questions
I’m requesting (check one):
Group play time
Private play time
None
Rate your dog's energy level between 1 (low) and 5 (high)
Please enter a number from
1
to
5
.
Does your dog have any activity restrictions/injuries we should be aware of? If so, please explain.
How often is your dog socialized outside your home?
Often
Occasionally
Rarely
Never
Has your dog ever shown aggressive behavior towards other dogs or people? If so please explain.
Behavior issues – triggers aggressive, fearful, out of control responses. Check all that apply.
Being picked up
Collar grasped
Dogs in general or particular type
Door bells
Hats/uniforms
Leashing
Loud vehicles/noises
Children
men
Strangers
Vacuums/shovels/mops
Fireworks/storms
Vacuums/shovels
Other
If "Other," please explain
Fixations/Obsessions/Phobias (Check all that apply)
Balls/toys
Cats/squirrels
Digging
Feces/rocks (ingestion)
Food/treats
Insects
Reflections/shadows
Other
If "Other," please explain
Can your dog jump a 6ft fence?
Yes
No
Please list any more information that you think we should know about your dog to provide the best care possible (fears, likes, dislikes).
Can we use videos and/or photos of your pet taken at Perfect 10 Boarding for future marketing?
Yes
No
Please submit a new questionnaire if any of the above information changes.
Pets are required to have updated rabies, distemper and bordatella records on file at Perfect 10 Boarding, LLC. Flea and tick guard is highly recommended. Please have records sent PRIOR to check in.
Please be aware that your dog’s stay at Perfect 10 Boarding, LLC is not without risk. Every effort will be made by our staff to provide a safe environment for your dog. Should your dog require medical attention, we will contact you immediately at the number above and transport your dog to a veterinarian.
You are responsible for any damages or injury incurred during your dog’s stay. Vet charges due to your dog or injury to another dog, caused by your dog, will be the responsibility of you and/or the owner of the dog.
By clicking the submit button, I agree to the above, accept full responsibility for the acts of my dog while at Perfect 10 Boarding, LLC and release them from any and all claims of liability.
Comments
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