New Client Intake

Welcome! Please fill out the form below to get your dog set up at The Rovervelt.

Tell us about you

Name* Required.

Additional Parent Name

Address* Required.

City* Required.

State* 2-letter state code.

Zip* 5-digit zip.

Cell phone* 10-digit phone.

Work phone 10-digit phone.

Email* Valid email.

Emergency contact* Required.

Emergency phone* 10-digit phone.

Authorized to pick up your dog

Name

Phone

How did you hear about us?

Referred by

Tell us about your dog(s)

Dog 1

Name* Required.

Age (years)

Breed

Color

Weight (lb)

Sex Male Female

Spayed / Neutered Yes No

Behavior

How long has the dog been in your family?

Does your dog get along with other dogs?

Has your dog ever bitten another dog or person?* Required — please answer (Yes / No / details).

Does your dog snap or growl when food or toys are taken away?

Does your dog growl or snap for any other reason?

How does your dog behave at a daycare/boarding facility?

How does your dog behave in public?

What commands does your dog know?

Has your dog ever climbed or jumped a fence?

Please describe any behavioral problems you might know of

Is there anything else we should be aware of?

Health

Veterinarian* Required.

Vet phone

List all allergies

Describe any medical conditions

Monthly Heartworm treatment

Monthly Flea treatment

Required vaccinations: Rabies, Leptospirosis, Distemper, Parvo, & Bordatella (Kennel Cough)

Please attach a copy or email to Roverveltguest@yahoo.com.

Attach vaccination records PDF or photo, max 10 MB.

If you did not attach records above, I acknowledge that I will email a copy of my dog's vaccination records to Roverveltguest@yahoo.com before my dog's first visit.* Either attach records above or check this box.

Email me a copy of my submission