Client Profile Form

    Your Dog's Name (required)

    Your Dog's Birthdate

    Your Dog's Breed(s)

    Is your Dog liscensed by the city of Toronto?

    YesNo

    Tag #

    Owner's First Name (required)

    Owner's Last Name (required)

    Owner's Address (required)

    Your Email (required)

    Primary Phone Number (required)

    Emergency Contact Name (required)

    Emergency Contact Phone Number (required)

    Veterinary Clinic Name (required)

    Veterinarian First Name (required)

    Veterinarian Last Name (required)

    Veterinarian Phone Number (required)

    Is your dog spayed or neutered? (required)

    YesNo

    Does your dog have the following vaccinations?
    (required)

    Rabies(required)

    Distemper

    Parvovirus

    Bordetella

    leptospirosis

    Is your dog micro-chipped? (if so input number; if not, leave blank)
    (required)

    Is your dog on flea or tick treatment? (required)

    YesNo

    Obedience

    Does your dog

    Sit (required)

    YesNo

    Stay (required)

    YesNo

    Come with reward (off leash)(required)

    YesNo

    Come without reward (off leash) (required)

    YesNo

    Fetch(required)

    YesNo

    Return(required)

    YesNo

    Walk with a slack leash(required)

    YesNo

    Walk abreast (off leash)(required)

    YesNo

    Walk abreast (off leash)(required)

    Socialization (with dogs) - Please select:


    Attends off-leash areas regularlyAttends or has attended doggy day-careHas attended puppy/dog socialization classes

    Socialization (with people) - Please select:


    Exposed to numerous people each dayFriendlyJumps upExcitable by strangersTimid of strangersThreatened by strangersNeutral to people

    Can your dog react to certain people, situations, or places? Please describe (leash tangles, children, other dog breeds, the vet, being in a car, etc.) (required)

    Is your dog possessive of food/balls/sticks/toys? (required)

    YesNo

    What is your dog's regular exercise routine?
    (required)

    Does your dog have any allergies? (Please list)


    Please list any health issues past/present/current that we should be aware of:


    Please describe any other concerns, habits, temperaments, or considerations not addressed above?


    When are you available for a free in-home consultation and brief walk?


    9:00 a.m. - 12:00 p.m12:00 p.m. - 3:00 p.m3:00 p.m. - 6:00 p.m6:00 p.m. - 9:00 p.m

    Please confirm you've read the Terms & Conditions before submitting:*

    I AGREE

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    Email

    info@wewillwalkyou.ca

    Telephone

    555-555-5555

     

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