Hassayampa Canine Resort & Spa Customer Information:
1. Last Name:
2. First Name:
3. Home Phone:
4. Business Phone:
5. Cell Phone:
6. Pager:
7. Email Address:
8. Address line 1:
9. Address line 2:
10. City, State Zip:
11. Local Emergency Contact:
12. Veterinarian Name:
13. Veterinarian Address:
14. Veterinarian Phone Number:
15. Animal Health Insurance:	Yes No
16. How did you hear about us?
Dog Information and Evaluation Form (One For Each Dog):
17. Owner Name:
18. Dog Name:
19. Primary Breed:
20. Description / Color:
21. Gender:
22. Spayed / Neutered:	Yes No
23. Date of Birth: (Month/Day/Year)
24. Has your dog lived with you for less than two months?	Yes No
25. Weight:
26. Licensed:	Yes No
27. Tattoo or MicroChip-Details:
28. Flea/Tick Program:	Yes No
29. Feeding / Medication Instructions:
30. How many times a day do you feed your dog?	1x 2x 3x
31. Food Brand & Type:
32. At feeding times does your dog eat fast or slow?
33. Pet Habits, Unusual or Repetitive Behaviors, Allergies or Additional Information:
34. Does your dog have any current health concerns?	Yes No
If yes, please explain:
35. Has your dog had injuries or health concerns in the past?	Yes No
If yes, please explain:
36. Does your dog go to a dog park or doggie day care?	Yes No
If yes, were there any problems? please explain:
37. Has your dog ever been in a fight? Does your dog's behavior depend on the size, breed or gender of other dogs?	Yes No
If yes, please explain.
38. Is your dog food or toy possessive?	Yes No
39. Has your dog been left overnight before?	Yes No
40. Were there any behavioral problems either while you were away or upon your return?	Yes No
If yes, please explain.
41. Has your dog ever run away for any reason (chasing cat, dog, looking for you, etc?	Yes No
If yes, please explain.
42. Please describe your dog's general temperament.
Examples: Outgoing, Verbally Sensitive, Timid, Affectionate, Pushy, Independent, Reserved, Confident, Submissive, Clingy, Excitable, Playful, Gentle, Mouthy
43. Please describe your dog's general physical condition.
44. Is your dog house trained?	Yes No
45. Has your dog had any obedience training?	Yes No
46. Describe your dog’s activity level:
47. How would you describe your dog’s demeanor while riding in a car?
48. Does your dog defecate or vomit while riding in a car?	Yes No
49. Does your dog normally ride in a crate while in a car?	Yes No
50. Describe situations when your dog may become unfriendly:
Examples:  Grabbing collar, Hugging, Removing from furniture, Touching while sleeping,  Touching ears/paws/mouth/tail, Around other dogs
51. Describe your dog’s unfriendly behavior:
Examples: Will bite, May bite, Growls, Snaps, Shows teeth, Freezes, Trembles, Moves away
52. Has your dog ever bitten a person?	Yes No
53. Has your dog ever bitten another dog?	Yes No