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Guest Questionnaire:
What is the current health condition of your dog?
□ Excellent
□ Good
□ Fair
□ Poor
Where did you get your dog?
□ Breeder
□ Pet Store
□ Animal Shelter
□ Family / Friend
□ Other:____________
Has your dog been in daycare/ boarding before?
Is your dog’s activity level:
Describe your dog’s personality: (check all that apply)
Describe possible situations where your dog may become unfriendly: (check all that apply)
Describe your dog’s unfriendly behavior (Circle all that apply):
Is she/he afraid of the following:
Commands Used: (If you use another word or language, please write in your command)
Please describe/note any of the following conditions that may apply
□ Diabetic□ Epileptic□ AllergiesThe information provided in this profile is true, correct and complete. If my application is accepted, any misstatement or omission of fact on this profile may result in my pet’s dismissal from Safe Haven Pet Resort. I hereby authorize an investigation of all information contained in this profile and I specifically release from all liability Safe Haven Pet Resort, or its designees, and any persons, companies, and/or corporations who may be contracted to verify or supplement any information I have provided. Thank you for filling out this profile, it will help us in the care of your loved one!
Name (Print): _______________________________________________________________________________
Signature: ___________________________________________________ Date: _________________________
□ Excellent
□ Good
□ Fair
□ Poor
How long have you owned your dog? ________________
Has your dog been diagnosed with any communicable disease, bacteria or parasite in the past 30 days? Yes | NO
If yes, please describe: __________________________________________________________________________
□ Yes
□ No
□ Low
□ Medium
□ High
□ Outgoing
□ Submissive
□ Timid
□ Affectionate
□ Clingy
□ Excitable
□ Playful
□ Gentle
□ Mouthy
□ Shy
□ Protective
□ Nervous
□ Pushy
□ Independent
□ Reserved
□ Confident
□ Aggressive
□ Verbally sensitive
□ Food bowl
□ Grabbing collar
□ Toys
□ Rawhides/Bones
□ Touching while sleeping
□ Touching ears | paws | tail | mouth
□ Dogs
□ People
□ Hugging / Restraining
□ Other: _____________
□ Will bite
□ May bite
□ Shows teeth
□ Trembles
□ Growls
□ Snaps
□ Runs away
□ Unknown
□ Thunder
□ Loud Noises
□ Being left alone
□ Vacuum
□ None of the above
□ Other:____________
□ Sit
□ Stay
□ Come
□ Down
□ No
□ No Bark
□ Hush
□ Other:______________
□ Sore Joints
□ Ear and/or Skin infections
□ currently under a Veterinarian’s Care, etc.
