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Educational template — customize terms for your business and seek qualified advice where appropriate. Use your browser's Print or Save as PDF command. Do not send completed private information to this public page.
Basic Information
Dog's Name:
Nickname:
Breed:
Mix / Other:
Date of Birth (approx.):
Age:
Weight:
Color & Markings:
Sex:
Spayed / Neutered?:
Microchip ID #:
License Tag #:
Owner & Emergency Contact
Owner Name:
Phone (Primary):
Email:
Secondary Contact Phone:
Emergency Contact Name:
Emergency Contact Phone:
Veterinary Information
Veterinary Practice:
Veterinarian Name:
Vet Phone:
Vet Address:
Emergency Vet Clinic:
Emergency Vet Phone:
Medical Information
Vaccinations: □ Rabies □ Distemper/Parvo (DHPP) □ Bordetella (Kennel Cough) □ Leptospirosis □ Lyme Disease □ Influenza
Vaccination expiry dates or notes:
Flea/Tick Prevention (product & frequency):
Heartworm Prevention (product & frequency):
Current Medications (name, dosage, frequency, instructions):
Known Allergies (food, environmental, medications):
Medical Conditions / Chronic Issues:
Last Vet Visit (approx.):
Date of Last Heartworm Test:
Any upcoming surgeries, procedures, or health concerns?:
Feeding & Routine
Food Brand & Type:
Amount per meal:
Feeding times:
Treat preferences / restrictions:
Food storage location:
Special dietary instructions or restrictions:
Typical potty schedule:
Normal outdoor elimination habits:
Behavioral Notes
General temperament: □ Friendly with people □ Shy / Reserved □ Anxious / Fearful □ Energetic / High-drive □ Calm / Mellow □ Playful □ Protective / Territorial □ Food motivated □ Toy motivated
Known triggers or fears (thunderstorms, loud noises, specific objects, etc.):
Behavior around unfamiliar dogs:
Behavior around unfamiliar people (children, men, strangers, etc.):
On-leash behavior (pulling, reactivity, etc.):
Off-leash behavior & recall reliability:
Known issues: □ Resource guarding (food/toys) □ Leash reactivity □ Dog aggression □ Human aggression □ Escape artist / bolting □ Excessive barking □ Separation anxiety □ Jumping / mouthing
Handling Instructions
Commands this dog knows and responds to:
How to handle on leash (preferred equipment: harness, flat collar, Martingale, etc.):
How to best redirect negative behavior:
What calms this dog when anxious or overstimulated:
Any special handling requirements, physical limitations, or injuries:
Favorite activities, toys, or games:
Anything else the walker/caregiver should know:
Signature
I confirm the information above is accurate and current. I will notify my provider immediately of any changes to my pet's health, behavior, medications, or status.
Owner Signature:
Date: