Owner Information

    First Name
    Last Name
    Street Address
    City
    Province
    Postal Code
    Mobile Phone
    Home Phone
    Work Phone
    Email Address
    Secondary Owner Name
    Secondary Owner Phone
    Secondary Owner Email
    How did you hear about us?
    Provide their name and they’ll receive $10 off!
    Provide other referral

    Emergency Contact

    (someone we can release the dog to in the event you cannot pick up your pet)

    Name
    Phone
    Email

    Veterinarian Information

    Business Name
    Veterinarian Name
    Phone Number

    Pet Information

    Pet Name
    Birth Date
    Breed
    Gender
    Spayed/Neutered
    Weight
    Color/Markings

    Health & Grooming

    Blind
    Diabetic
    Allergies
    Biter
    Barker
    Deaf
    Epileptic
    Sensitive Skin
    Shy/Nervous
    Hyper
    Heart Condition
    Musculoskeletal Issues
    Warts/Moles/Skin Tags
    Comfortable in a Crate
    Does your pet currently have fleas or ticks? (There may be an extra charge for removal or treatment.)
    Aggressive Triggers
    Sensitive Areas
    Professionally groomed before?
    Scared of hair dryer?
    May we give your dog treats?
    Shampoo preference?