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ABOUT
Diamond Creek Pet Retreat & The Canine Sports Center
For all your pets' needs
6/30/13 Intro to Flyball Seminar/
MORE EVENTS /
CONTESTS
PET PROFILE FORM
PetProfileForm
By
diamonds56
|
Published:
December 1, 2012
Step 1 of 5
20%
OWNER INFORMATION:
Owner's Name
*
First
Last
Alternate Contact Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Home Phone
*
(###) ### - ####
Cell Phone
*
(###) ### - ####
Alternate Cell Phone
(###) ### - ####
Work Phone
(###) ### - ####
Email
*
Enter Email
Confirm Email
How did you find out about Diamond Creek Pet Retreat?
*
PET INFORMATION:
Guest's Name
*
Species
*
Dog
Cat
Other
Other:
*
Please enter species if not dog or cat
Breed/Breed Mix
*
Sex
*
Male
Female
Neutered?
*
Yes, Neutered Male
No, Intact
Spayed?
*
Yes, Spayed
No, Intact Female
Color/Markings
*
Date of Birth:
*
MM
DD
YYYY
Actual or approximate date
Pet's Weight
*
Is your cat declawed?
*
No
Yes, Front only
Yes, Front AND Back
Veterinarian
*
Veterinarian Practice Name
*
Veterinarian Phone
*
(###) ### - ####
FEEDING INFORMATION:
Brand of pet food (dry/canned) that you feed at home
*
What is the main protein source in the food? (i.e. chicken, beef, lamb, etc.)
*
(This information can be found as the first ingredient on the food label)
Do you raise the food or water levels higher than the pet's chest level?
*
Yes
No
(Usually done for large or giant breeds.)
How many times a day do you feed?
*
Once
Two Meals
Three Meals
Free Feed
Select one
**We do not recommend free feeding because we prefer to monitor a pet’s food intake while residing with us. However, we will do so if this is what you do at home.**
Once a day - am or pm?
*
AM
PM
How much food by measured 8oz cup per serving?
*
Daily total food by measured 8oz cup?
*
Do you add anything to the dry food (i.e. canned food, water, broth, yogurt...)?
*
Yes
No
If "yes" what is added?
*
Canned Food
Water
Broth
Yogurt
Treats
Other (please specify in the space below)
Check all that apply
Special Diet/Feeding instructions:
*
List any additional items added to pet's food or information on feeding that may be helpful to the caregivers - if nothing to note please type "none".
If your pet runs out of the food you have provided while in our care what would you like us to do?
*
Switch to Retreat food
Maintain diet and replenish supply at additional cost
N/A will be on Retreat food for duration of care
MEDICAL AND GENERAL HEALTH INFORMATION:
Any known allergies (i.e. shampoos, perfumes, types of food etc.)?
*
Please also list if owner is allergic to any of the listed items and indicate "owner allergy" - if noting to note please type "none".
Please list any long term or recurring medical conditions (i.e. ear infections, tick borne illness, urinary incontinence):
*
If nothing to note please type "none"
Is your pet taking long-term medicines or supplements (NOT including monthly preventative medications such as flea/tick or heartworm treatments)?
*
No
Yes, 1 medication/supplement
Yes, 2 medications/supplements
Yes, 3+ medications/supplements
Medication/Supplement #1
Medication/Supplement Name:
*
Prescribed/Used for:
*
Dosage amount
*
Dispensed in
*
AM
Noon
PM
Other (give details below)
Check all that apply
Dispensing time details
*
If meds are given at a specific time other than with meals please give details here.
Adminstered by
*
In food
In treat
Manually
Topical application
Medication/Supplement #2
Medication/Supplement Name
*
Prescribed/Used for
*
Dosage Amount
*
Dispensed in
*
AM
Noon
PM
Other (give details below)
Check all that apply
Dispensing time details
*
If meds are given at a specific time other than with meals please give details here.
Administered by
*
In food
In treat
Manuall
Topically
Medication/Supplement #3
Medication/Supplement Name
*
Prescribed/Used for
*
Dosage Amount
*
Dispensed in
*
AM
Noon
PM
Other (give details below)
Check all that apply
Dispensing time details
*
Administered by
*
In food
In treat
Manually
Topically
If your pet is taking more than 3 medications or supplements on a regular basis please include details here.
*
If no additional medications or supplements are given please type "n/a" or "none"
Does you pet normally get any of the following items at home without supervision?
*
NONE
Bedding, non-stuffed (ie sheet)
Bedding, stuffed (ie dog bed or comforter)
Nylabones
Kongs, empty
Kongs, stuffed (indicate stuffing preferances in notes at below)
Other toys (please include details in box below)
Check all that apply
Additional information on approved items:
*
Please provide information on stuffing for kongs or other toys/belongings your pet generally has when unsupervised in this space.
Does your pet have reactions to any of the following situations?
*
NONE
Thunderstorms
High Winds
Extreme heat (over 90 degrees)
Extreme cold (below 20 degrees)
Fireworks
Loud Noises
Check all that apply
Please explain the reactions you see from your pet to the above situations
*
Tell us about your pet. What should we know so that we may provide the best care to him/her?
*
Information on any set routine, command words, behavior quirks etc.
Has your pet every stayed away from home and family before?
*
Yes
No
Were there any behavioral/medical concerns that you were made aware of?
*
Yes
No
Please explain the behavioral/medical concerns from previous time away from home and family.
*
Are there any food possession/toy possession issues?
*
NONE
YES, FOOD - with animals
YES, FOOD - with people
YES, TOYS - with animals
YES, TOYS - with people
check all that apply
Please provide details on possession issues:
*
Will more than one pet be staying with us at the same time?
*
No
Yes
Will the pets be sharing a suite during their stay?
*
No, separate suites
Yes, shared suites
No, dog/cat combo
For pets sharing a suite, do they need to be supervised or separated during feeding?
No
Yes, supervised
Yes, separated by a few feed
Yes, separated completely, one inside and one outside
Reason for supervision or separation during meals
*
ie - possible fighting, special diets, meds in food...
If in separate suites can they share potty breaks and playtimes?
*
Yes
No, keep separate at all times
Additional Information
Please provide any other info that will be helpful to our caregivers during your pet's stay.
Date Completed
*
Please choose today's date
We appreciate you taking the time to complete this form and for providing the necessary information to give your pet the best care possible while at our facility.
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