CANINE COMPANION INFORMATION SHEET
Name of client: ________________________________________________
Name of dog: ___________________________________________________
Age: _______ Breed: ______________ Sex: F/M
Spayed ___Yes___No Neutered: ___Yes___No
Colour: __________________________________________________________
Markings: _______________________________________________________
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Weight: _______ Rabies tag #: ____________
Date of Vaccination: _________ 1 or 3 year shot
Please answer yes or no:
1. Jumps on people YES / NO
2. Plays with balls or toys YES / NO
3. Digs holes YES / NO
4. Likes children YES / NO
5. Gets along with other dogs YES / NO
6. Likes adults YES / NO
7. May be given treats YES / NO
8. Must remain on a leash or harness while on walks YES / NO
9. Is afraid of thunder, fireworks or other loud noises YES / NO
10. Chases cats/squirrels YES / NO
11. Barks at strangers or other dogs YES / NO
12. Gets into garbage YES / NO
13. Is allowed on furniture YES / NO
14. Chews on things YES / NO
15. Has other fears YES / NO
16. Enjoys cuddling YES / NO
17. Obeys commands YES / NO
18. Has allergies? YES / NO If so, to what?
19. Favourite hiding places? YES / NO
20. Has the dog ever bitten anyone? YES / NO Why?
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21. Does the dog show any other signs of aggression? YES / NO
21a. If yes to the above what are the triggers? Reactions?
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22. Is protective of the home YES / NO
23.I s protective of food, water, toys etc. YES / NO Additional comments: __________________________________________________________________
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Does your dog wear different leashes for walks, such as a halti, gentle leader, choke chain or prong collar: __________________________________________________________________
Does your dog have a favourite game? __________________________________________________________________
Dog's background (i.e. adopted from pound, purchased as a puppy etc.): __________________________________________________________________
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Medical history: __________________________________________________________________ __________________________________________________________________
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Brand of food - Specify kibble, canned, cooked or raw: __________________________________________________________________
Specific feeding instructions: __________________________________________________________________
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Emergency contact information: Name: __________________________________________________________________
Relationship To Client: __________________________________________
Address: _________________________________________________________
Phone Number: __________________________________________________
Veterinarian information: Name of Vet: ___________________________________________________________________
Name of Clinic: __________________________________________________
Address: _________________________________________________________
Phone Number: __________________________________________________
Special Instructions: ___________________________________________________________________
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I, the client, certify that the above is true and complete to the best of my knowledge. I will notify T Wheat's Paw-2-Purr-Fect
Pet & House Sitting Service of any changes in writing prior to the commencement of any service period.
Client Name, Printed_____________________________________________
Client Name, Signature___________________________________________
Date: ___________________________________
