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? —Please choose an option—Google/InternetYellowpagesYelpGoogle AdsFriendOther
Provide their name and they’ll receive $10 off!
Provide other referral
(someone we can release the dog to in the event you cannot pick up your pet)
Name
Phone
Email
Business Name
Veterinarian Name
Phone Number
Pet Name
Birth Date
Breed
Gender MaleFemale
Spayed/Neutered YesNo
Weight
Color/Markings
Blind NoYesUnknown
Diabetic NoYesUnknown
Allergies NoYesUnknown
Biter NoYesUnknown
Barker NoYesUnknown
Deaf NoYesUnknown
Epileptic NoYesUnknown
Sensitive Skin NoYesUnknown
Shy/Nervous NoYesUnknown
Hyper NoYesUnknown
Heart Condition NoYesUnknown
Musculoskeletal Issues NoYesUnknown
Warts/Moles/Skin Tags NoYesUnknown
Comfortable in a Crate NoYesUnknown
Does your pet currently have fleas or ticks? (There may be an extra charge for removal or treatment.) NoYesUnknown
Aggressive Triggers CagesPeopleAnimalsOther
Sensitive Areas
Professionally groomed before? YesNo
Scared of hair dryer? YesNo
May we give your dog treats? YesNo
Shampoo preference? DeodorizingOatmealHypoallergenicFun-Scented
By submitting this form I hereby agree to the terms, conditions and policies outlined by Pooch Proper: Terms, Conditions and Policies.
