Intake Form

Waggerz’ Lounge Intake Form — One form per dog please.
Please fill out this Intake Form or you may print this Intake Form and then fill it out and bring it to us when we meet.

    How did you hear about us?

    Contact Information:

    Emergency Contact Information:

    Veterinary Information:

    Pet Information:

    MaleFemale

    Spayed/neutered?
    YesNoNot Sure

    Microchip?
    YesNo

    Where did you get this dog?

    How long have you had him/her?

    If you have not had him / her from puppyhood, what do you know of the dog’s prior history?

    Are there any other animals in the household? (Species/Breed/Age)

    Has your dog ever participated in daycare or played in off leash dog parks?

    Please describe your dog’s overall temperament.

    How does your dog interact with other dogs? (Generally)

    Has your dog ever bitten a person?
    YesNo

    Has your dog ever bitten a dog?
    YesNo

    Are there any particular types of people your dog seems to fear or dislike?
    YesNo

    If yes, please explain:

    Has your dog ever tried to escape (home, backyard, vet, etc.)?
    YesNo

    Does your dog jump fences?
    YesNo

    Will your dog share water with other dogs?

    Does your dog have any sensitive areas on his / her body?
    YesNo

    If yes, please explain:

    Does your dog have any allergies?
    YesNo

    If yes, please explain:

    Does your dog have any disabilities or health problems?
    YesNo

    If yes, please explain:

    Is your dog on tick and flea preventative?
    YesNo

    Is your dog on a worm/parasite preventative (ie. Heartgard, Sentinel, Advantage, Ivermectin/Pyrantel, etc.)?
    YesNo

    If yes, what is the brand?