QUESTIONNAIRE

Start your journey with us, it’s an Adventure worth barking about!

Share your
Information below

Client Name:

Client Contact Number

Client Email Address

Client Address

Emergency Contact Name:

Emergency Contact Number

Preferred Veterinary Clinic Address

Preferred Veterinary Clinic Contact Number

In an emergency, will you allow Paws & Peaks to contact you swiftly &/or transport your dog to the nearest clinic?

Yes No

Dog’s Name

Breed

Male/Female

Is your dog desexed?

Age/DOB

Microchip Number

Crate Trained

Is your dog an escape risk?

Behavioural issues?

Any medical conditions?

Any medication/s for medication conditions?

Is your dog up to date with vaccinations (minimum C5)

Is your dog on flea/tick/worm treatment?

Is your dog registered with the local council?

Are there any nicknames your dog goes by?

Is there anything else you think we need to know about your dog