Check In Form

THE PAMPERED POOCH

Vacation retreat and grooming studio

Date: __________________

PET:

NAME ____________________________ AGE ____ BREED ____________________________

COLOR____________________________ M Fr

OWNER:

NAME_________________________________________________________________________

ADDRESS______________________________________________________________________

PHONE ___________________ CELL __________________ E-MAIL _______________________

VETERINARIAN ________________________________________ PHONE ___________________

EMERGENCY CONTACT # ____________________ NAME ________________________________

PLAYS WELL WITH OTHERS YES NO

TOY POSSESSIVE YES NO

SEPARATION ANXIETY YES NO

TEMPERAMENT: i.e. Destructive behavior, scared of thunder...

______________________________________________________________________________

______________________________________________________________________________

ACTIVITY LEVEL: _______________________________________________________________

SPECIAL NEEDS: _______________________________________________________________

CAN WE GIVE YOUR POOCH A TREAT AT NAP TIMES: YES NO

FEEDING/amount: ________________________

AM _________________________________ PM _____________________________________

MEDICATION: _________________________________________________________________

ALLERGY: ____________________________________________________________________

UP TO DATE VACATION COPY: ________________ NEUTERED: SPAYED:

ADDITIONAL INFORMATION:

 © 2010 Pampered Pooch Retreat all rights reserved