THE PAMPERED POOCH

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Vacation retreat and grooming studio

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Date: __________________

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PET:

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NAME ____________________________ AGE ____ BREED ____________________________

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COLOR____________________________ M Fr

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OWNER:

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NAME_________________________________________________________________________

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ADDRESS______________________________________________________________________

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PHONE ___________________ CELL __________________ E-MAIL _______________________

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VETERINARIAN ________________________________________ PHONE ___________________

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EMERGENCY CONTACT # ____________________ NAME ________________________________

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PLAYS WELL WITH OTHERS YES NO

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TOY POSSESSIVE YES NO

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SEPARATION ANXIETY YES NO

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

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______________________________________________________________________________

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______________________________________________________________________________

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ACTIVITY LEVEL: _______________________________________________________________

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SPECIAL NEEDS: _______________________________________________________________

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

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FEEDING/amount: ________________________

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AM _________________________________ PM _____________________________________

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MEDICATION: _________________________________________________________________

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ALLERGY: ____________________________________________________________________

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UP TO DATE VACATION COPY: ________________ NEUTERED: SPAYED:

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ADDITIONAL INFORMATION: