NEW CLIENTS This my intake form for new clients. Please submit prior to scheduling a meet & greet. Thank you! Please enable JavaScript in your browser to complete this form.12345Name *FirstLastEmail *EmailConfirm EmailPhone *Services: *Dog WalkingDrop-In VisitsHouse SittingFarm CaretakingGroup OutingsPrivate OutingsBoardingDoggy Day CarePet TransportOther Service:LayoutService Start Date *Service End DateNotes:Street Address *City, State, Zip Code *FirstMiddleLastDogs 0 Dogs Cats 0 Cats Chickens 0 Chickens Horses 0 Horses Layout (copy)Cattle 0 Head of Cattle Goats 0 Goats Rabbits 0 Rabbits Other Animals 0 Animals What species? *Notes:NextField #63 (copy) (copy)DOG INFOONE DOG PER SECTIONField #63 (copy) (copy) (copy) (copy)Dog's Name *Weight *Sex *MaleFemaleAge or DOB *Breed(s) *S/N Status *Neutered/SpayedIntactWhich vaccines are up-to-date for your dog? *RabiesDistemper-ParvoBordatellaLeptoCanine InfluenzaNoneUnknown1. How is your dog with new people? *FriendlyCautiousAloofAggressiveGuards Food or Water BowlGuards Crate or BedGuards Toys or BallsGuards Kongs or ChewsNoneUnknownNotes:2. How is your dog with new dogs? *FriendlyCautiousAloofAggressiveGuards Food or Water BowlGuards Crate or BedGuards Toys or BallsGuards Kongs or ChewsNoneUnknownNotes:3. What’s your dog’s typical daily routine? Favorite things to do or places to go? *4. Has your dog shared their space with new or visiting dogs? If so, how did it go? *5. For how many hours can your dog be comfortably left between potty breaks? *0 hours / Still House Training1 hour2 hours3 hours4 hours5 hours6 hours7 hours8 hoursUnknownNotes:6. Is your dog crate trained? *YesNot since they were a puppyNoUnknownNotes:7. Does your dog have separation anxiety? *None — rests quietly when alone in home, vehicle or crate; may whine or bark at first but quiets quicklyMild — needs chew toy or other distraction in order to rest when crated or alone in home/vehicle; may whine or bark with or without distractionModerate — doesn’t rest when crated or alone in home/vehicle even with distractions; may injure themselves or damage property when alone; barks; whinesSevere — attempts to escape when crated or alone in home/vehicle; injures themselves; damages property; barks or whines without stoppingUnknownNotes:8. How does your dog behave in the car? *Does best when cratedDoes best when tetheredSleeps/RestsPacesVomits/DroolsWhinesLunges at passing carsLunges at passing peopleNoneUnknownNotes:9a. How does your dog typically behave off-leash (i.e. beach, unfenced area)? *Good recall with ownerGood recall with new people Poor recall off-leash/Does come when calledRecall is better with treatsRecall is better with toy/squeakerWants to runWants to play fetchWants to play with other dogsWants to jump in waterWill follow a scent Scared of loud noises (i.e. thunder, gunshot)Plays keep-away/won't go back on-leashWill chase moving vehiclesWill chase bikes/skateboardsWill go towards peopleWill go towards dogs Unknown/My dog is rarely off-leashOther:Check any that applyNotes:9b. What equipment does your dog typically use when off-leash? *No additional equipmentLong lineRemote collarGPSOther:Check any that applyNotes:10a. How does your dog typically behave on-leash? *Walks with loose leash (no pulling)Pulls intermittently (i.e. towards a person, a dog)Pulls consistently Lunges at dogs/ReactiveLunges at people/ReactiveLunges at bicycles/skateboardsLunges at moving vehiclesIs scared of moving vehiclesPuts on the brakes/won't walk on-leashUnknown/My dog is rarely on-leashOther:Check any that applyNotes:10b. What equipment does your dog typically use when on-leash? *Flat CollarMartingale CollarBalance/Roman Body HarnessStep-In/Easy Walker Body HarnessHead Collar (Halti, Gentle Leader)Prong CollarChoke CollarMy dog is not leash trainedCheck any that applyNotes:11. Are there any other traits about your dog that I should be aware of? *General anxietyFear of loud noisesStrong prey driveChases bikes, cars, other wheelsJumps fenceReactivity towards peopleReactivity towards dogsRedirect bites when stressedCompulsive barkingCompulsive ingestion of non-food items (pica)NoneUnknownNotes:Field #63 (copy) (copy) (copy) (copy)12. Feeding amount & schedule: *14. Any food, medication or environmental allergies? *13. Any medications? *15. Any medical conditions or injuries that I should be aware of? *Anything else you'd like me to know about your dog?Field #63 (copy) (copy) (copy)DOG #2Dog's Name *Weight *Sex *MaleFemaleAge or DOB *Breed(s) *S/N Status (copy) *Neutered/SpayedIntactWhich vaccines are up-to-date for your dog? *RabiesDistemper-ParvoBordatellaLeptoCanine InfluenzaNoneUnknown1. How is your dog with new people? *FriendlyCautiousAloofAggressiveGuards Food or Water BowlGuards Crate or BedGuards Toys or BallsGuards Kongs or ChewsNoneUnknownNotes:2. How is your dog with new dogs? *FriendlyCautiousAloofAggressiveGuards Food or Water BowlGuards Crate or BedGuards Toys or BallsGuards Kongs or ChewsNoneUnknownNotes:Field #188 (copy)3. What’s your dog’s typical daily routine? Favorite things to do or places to go? *4. Has your dog shared their home with new or visiting dogs? If so, how did it go? *5. For how many hours can your dog be comfortably left between potty breaks? *0 hours / Still House Training1 hour2 hours3 hours4 hours5 hours6 hours7 hours8 hoursUnknownNotes:6. Is your dog crate trained? *YesNot since they were a puppyNoUnknownNotes:7. Does your dog have separation anxiety? *UnknownNone — rests quietly when alone in home, vehicle or crate; may whine or bark at first but quiets quicklyMild — needs chew toy or other distraction in order to rest when crated or alone in home/vehicle; may whine or bark with or without distractionModerate — doesn’t rest when crated or alone in home/vehicle even with distractions; may injure themselves or damage property when alone; barks; whinesSevere — attempts to escape when crated or alone in home/vehicle; injures themselves; damages property; barks or whines without stoppingNotes:8. How does your dog behave in the car? *Does best when cratedDoes best when tetheredSleeps/RestsPacesVomits/DroolsWhinesLunges at passing carsLunges at passing peopleNoneUnknownNotes:9a. How does your dog typically behave off-leash (i.e. beach, unfenced area)? *Good recall with ownerGood recall with new people Poor recall off-leash/Does come when calledRecall is better with treatsRecall is better with toy/squeakerWants to runWants to play fetchWants to play with other dogsWants to jump in waterWill follow a scent Scared of loud noises (i.e. thunder, gunshot)Plays keep-away/won't go back on-leashWill chase moving vehiclesWill chase bikes/skateboardsWill go towards peopleWill go towards dogs Unknown/My dog is rarely off-leashOther:Check any that applyNotes:9b. What equipment does your dog typically use when off-leash? *No additional equipmentLong lineRemote collarGPSOther:Check any that applyNotes:10a. How does your dog typically behave on-leash? *Walks with loose leash (no pulling)Pulls intermittently (i.e. towards a person, a dog)Pulls consistently Lunges at dogs/ReactiveLunges at people/ReactiveLunges at bicycles/skateboardsLunges at moving vehiclesIs scared of moving vehiclesPuts on the brakes/won't walk on-leashUnknown/My dog is rarely on-leashOther:Check any that applyNotes:10b. What equipment is typically used for walking your dog? *Flat CollarMartingale CollarBalance/Roman Body HarnessStep-In/Easy Walker Body HarnessHead Collar (Halti, Gentle Leader)Prong CollarChoke CollarMy dog is not leash trainedNotes:11. Are there any other traits about your dog that I should be aware of? *General anxietyFear of loud noisesStrong prey driveChases bikes, cars, other wheelsJumps fenceReactivity towards peopleReactivity towards dogsRedirect bites when stressedCompulsive barkingCompulsive ingestion of non-food items (pica)NoneUnknownNotes:12. Feeding amount & schedule: *14. Any food, medication or environmental allergies? *13. Any medications? *15. Any medical conditions or injuries that I should be aware of? *Anything else you'd like me to know about your dog?DOG #3Field #208 (copy)Dog's Name *Weight *Sex *MaleFemaleAge or DOB *Breed(s) *S/N Status (copy) (copy) *Neutered/SpayedIntactWhich vaccines are up-to-date for your dog? *RabiesDistemper-ParvoBordatellaLeptoCanine InfluenzaNoneUnknown1. How is your dog with new people? *FriendlyCautiousAloofAggressiveGuards Food or Water BowlGuards Crate or BedGuards Toys or BallsGuards Kongs or ChewsNoneUnknownNotes:2. How is your dog with new dogs? *FriendlyCautiousAloofAggressiveGuards Food or Water BowlGuards Crate or BedGuards Toys or BallsGuards Kongs or ChewsNoneUnknownNotes:Field #188 (copy) (copy)3. What’s your dog’s typical daily routine? Favorite things to do or places to go? *4. Has your dog shared their home with new or visiting dogs? If so, how did it go? *5. For how many hours can your dog be comfortably left between potty breaks? *0 hours / Still House Training1 hour2 hours3 hours4 hours5 hours6 hours7 hours8 hoursUnknownNotes:6. Is your dog crate trained? *YesNot since they were a puppyNoUnknownNotes:7. Does your dog have separation anxiety? *UnknownNone — rests quietly when alone in home, vehicle or crate; may whine or bark at first but quiets quicklyMild — needs chew toy or other distraction in order to rest when crated or alone in home/vehicle; may whine or bark with or without distractionModerate — doesn’t rest when crated or alone in home/vehicle even with distractions; may injure themselves or damage property when alone; barks; whinesSevere — attempts to escape when crated or alone in home/vehicle; injures themselves; damages property; barks or whines without stoppingCheck all that applyNotes:8. How does your dog behave in the car? *Does best when cratedDoes best when tetheredSleeps/RestsPacesVomits/DroolsWhinesLunges at passing carsLunges at passing peopleNoneUnknownNotes:9a. How does your dog typically behave off-leash (i.e. beach, unfenced area)? *Good recall with ownerGood recall with new people Poor recall off-leash/Does come when calledRecall is better with treatsRecall is better with toy/squeakerWants to runWants to play fetchWants to play with other dogsWants to jump in waterWill follow a scent Scared of loud noises (i.e. thunder, gunshot)Plays keep-away/won't go back on-leashWill chase moving vehiclesWill chase bikes/skateboardsWill go towards peopleWill go towards dogs Unknown/My dog is rarely off-leashOther:Check any that applyNotes:9b. What equipment does your dog typically use when off-leash? *No additional equipmentLong lineRemote collarGPSOther:Check any that applyNotes:10a. How does your dog typically behave on-leash? *Walks with loose leash (no pulling)Pulls intermittently (i.e. towards a person, a dog)Pulls consistently Lunges at dogs/ReactiveLunges at people/ReactiveLunges at bicycles/skateboardsLunges at moving vehiclesIs scared of moving vehiclesPuts on the brakes/won't walk on-leashUnknown/My dog is rarely on-leashOther:Check any that applyNotes:10b. What equipment is typically used for walking your dog? *Flat CollarMartingale CollarBalance/Roman Body HarnessStep-In/Easy Walker Body HarnessHead Collar (Halti, Gentle Leader)Prong CollarChoke CollarMy dog is not leash trainedNotes:11. Are there any other traits about your dog that I should be aware of? *General anxietyFear of loud noisesStrong prey driveChases bikes, cars, other wheelsJumps fenceReactivity towards peopleReactivity towards dogsRedirect bites when stressedCompulsive barkingCompulsive ingestion of non-food items (pica)NoneUnknownNotes:Field #200 (copy)12. Feeding amount & schedule: *14. Any food, medication or environmental allergies? *13. Any medications? *15. Any medical conditions or injuries that I should be aware of? *Anything else you'd like me to know about your dog?Field #241 (copy)DOG #4Dog's Name *Weight *Sex (copy) *MaleFemaleAge or DOB *Breed(s) *S/N Status (copy) (copy) (copy) *Neutered/SpayedIntactWhich vaccines are up-to-date for your dog? *RabiesDistemper-ParvoBordatellaLeptoCanine InfluenzaNoneUnknown1. How is your dog with new people? *FriendlyCautiousAloofAggressiveGuards Food or Water BowlGuards Crate or BedGuards Toys or BallsGuards Kongs or ChewsNoneUnknownCheck all that applyNotes:2. How is your dog with new dogs? *FriendlyCautiousAloofAggressiveGuards Food or Water BowlGuards Crate or BedGuards Toys or BallsGuards Kongs or ChewsNoneUnknownCheck all that applyNotes:Field #188 (copy) (copy) (copy)3. What’s your dog’s typical daily routine? Favorite things to do or places to go? *4. Has your dog shared their home with new or visiting dogs? If so, how did it go? *5. For how many hours can your dog be comfortably left between potty breaks? *0 hours / Still House Training1 hour2 hours3 hours4 hours5 hours6 hours7 hours8 hoursUnknownNotes:6. Is your dog crate trained? *YesNot since they were a puppyNoUnknownNotes:7. Does your dog have separation anxiety? *UnknownNone — rests quietly when alone in home, vehicle or crate; may whine or bark at first but quiets quicklyMild — needs chew toy or other distraction in order to rest when crated or alone in home/vehicle; may whine or bark with or without distractionModerate — doesn’t rest when crated or alone in home/vehicle even with distractions; may injure themselves or damage property when alone; barks; whinesSevere — attempts to escape when crated or alone in home/vehicle; injures themselves; damages property; barks or whines without stoppingCheck all that applyNotes:8. How does your dog behave in the car? *Does best when cratedDoes best when tetheredSleeps/RestsPacesVomits/DroolsWhinesLunges at passing carsLunges at passing peopleNoneUnknownCheck all that applyNotes:9a. How does your dog typically behave off-leash (i.e. beach, unfenced area)? *Good recall with ownerGood recall with new people Poor recall off-leash/Does come when calledRecall is better with treatsRecall is better with toy/squeakerWants to runWants to play fetchWants to play with other dogsWants to jump in waterWill follow a scent Scared of loud noises (i.e. thunder, gunshot)Plays keep-away/won't go back on-leashWill chase moving vehiclesWill chase bikes/skateboardsWill go towards peopleWill go towards dogs Unknown/My dog is rarely off-leashOther:Check any that applyNotes:9b. What equipment does your dog typically use when off-leash? *No additional equipmentLong lineRemote collarGPSOther:Check any that applyNotes:10a. How does your dog typically behave on-leash? *Walks with loose leash (no pulling)Pulls intermittently (i.e. towards a person, a dog)Pulls consistently Lunges at dogs/ReactiveLunges at people/ReactiveLunges at bicycles/skateboardsLunges at moving vehiclesIs scared of moving vehiclesPuts on the brakes/won't walk on-leashUnknown/My dog is rarely on-leashOther:Check any that applyNotes:10b. What equipment is typically used for walking your dog? *Flat CollarMartingale CollarBalance/Roman Body HarnessStep-In/Easy Walker Body HarnessHead Collar (Halti, Gentle Leader)Prong CollarChoke CollarMy dog is not leash trainedNotes:11. Are there any other traits about your dog that I should be aware of? *General anxietyFear of loud noisesStrong prey driveChases bikes, cars, other wheelsJumps fenceReactivity towards peopleReactivity towards dogsRedirect bites when stressedCompulsive barkingCompulsive ingestion of non-food items (pica)NoneUnknownCheck all that applyNotes:Field #200 (copy) (copy)12. Feeding amount & schedule: *14. Any food, medication or environmental allergies? *13. Any medications? *15. Any medical conditions or injuries that I should be aware of? *Anything else you'd like me to know about your dog?CAT INFOONE CAT PER PAGE PLEASECat's Name *Any Medications? *Any medical conditions or injuries that I should be aware of? *Age / Breed(s) *Feeding Amount & Schedule *Anything else you'd like me to know about your cat? *Field #63 (copy) (copy) (copy) (copy)CAT #2Field #215 (copy)Cat's Name *Any Medications? *Any medical conditions or injuries that I should be aware of? *Age / Breed(s) *Feeding Amount & Schedule *Anything else you'd like me to know about your cat? *Field #63 (copy) (copy) (copy) (copy) (copy)CAT #3Field #215 (copy) (copy)Cat's Name *Any Medications? *Any medical conditions or injuries that I should be aware of? *Age / Breed(s) *Feeding Amount & Schedule *Anything else you'd like me to know about your cat? *Field #63 (copy) (copy) (copy) (copy) (copy) (copy)CAT #4Field #215 (copy) (copy) (copy)Cat's Name *Any Medications? *Any medical conditions or injuries that I should be aware of? *Age / Breed(s) *Feeding Amount & Schedule *Anything else you'd like me to know about your cat? *Field #63 (copy) (copy) (copy) (copy) (copy) (copy) (copy)CAT #5Field #215 (copy) (copy) (copy) (copy)Cat's Name *Any Medications? *Any medical conditions or injuries that I should be aware of? *Age / Breed(s) *Feeding Amount & Schedule *Anything else you'd like me to know about your cat? *CHICKEN INFOChicken Care & Health Info *Please include their feeding schedule & amounts, any current medications, medical conditions or past injuries. All pertinent info about their care, routine, health or safety is appreciated.HORSE INFOHorse Care & Health Info *Please include their feeding schedule & amounts, any current medications, medical conditions or past injuries. All pertinent info about their care, routine, health or safety is appreciated.CATTLE INFOCattle Care & Health Info *Please include their feeding schedule & amounts, any current medications, medical conditions or past injuries. All pertinent info about their care, routine, health or safety is appreciated.GOAT INFOGoat Care & Health Info *Please include their feeding schedule & amounts, any current medications, medical conditions or past injuries. All pertinent info about their care, routine, health or safety is appreciated.RABBIT INFORabbit Care & Health Info *Please include their feeding schedule & amounts, any current medications, medical conditions or past injuries. All pertinent info about their care, routine, health or safety is appreciated.OTHER ANIMALSOther Animal Care & Health Info *Please include their feeding schedule & amounts, any current medications, medical conditions or past injuries. All pertinent info about their care, routine, health or safety is appreciated.PreviousNextField #63 (copy) (copy)VETERINARIAN INFOVeterinarian / Animal Hospital *Veterinarian's City & State *Veterinarian's Email or Phone *Is this the current veterinarian for all of your animals? *YesNoWhich animals see this vet? *Field #63 (copy) (copy) (copy)VETERINARIAN INFO #2Veterinarian / Animal Hospital #2 *Veterinarian's City & State #2 *Veterinarian's Email or Phone #2 *Which animals see this vet? *PreviousNextField #63 (copy) (copy) (copy) (copy)PROPERTY INFOAny additional property care needed? *Water indoor plantsWater outdoor plantsBring in the mailBring in/out the trashNoneOther:Any other property info:Field #63 (copy) (copy) (copy)EMERGENCY CONTACTEmergency Contact Name *Emergency Contact Phone Number *Emergency Contact City & State *Is this an emergency contact for all of your animals? *YesNoThis emergency contact is for which animals? *Field #63 (copy) (copy) (copy) (copy)EMERGENCY CONTACT #2Emergency Contact Name #2 *Emergency Contact Phone Number #2 *Emergency Contact City & State #2 *This emergency contact is for which animals? *PreviousNextFeel free to send me photos or videos of your animals. Proof of vaccinations can be sent through this form or via email. * Click or drag files to this area to upload. You can upload up to 10 files. .pdf, .mov, .avi, .heic, .jpg, .jpeg, .png, .mp4Anything else that you'd like me to know about your animals or property?How did you hear about Kite Hill Canines? *Submit
