(203) 744-9247
68 Mill Plain Road
Danbury, CT 06811
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Owner Information
First Name:*
Last Name:*
State:*        Zip:*
Home Phone:*        Work Phone:        Cell Phone:
Services Interested In (please choose one or more)*
Daycare     Boarding     Training
How did you hear about us?*
Emergency Contact Information
Spouse/Significant Other
First Name:
Last Name:
Someone Outside Immediate Family
First Name:*
Last Name:*
Veterinarian Information
Doctor's Name:
State:   Zip:
Dog Information
Primary Breed:*
Sex:* Male Female
Neutered/Spayed:* Yes No
Birth Date:* (MM/DD/YYYY) If exact birth date not known, please enter an approximate date
Weight:*    lbs.
Where did you get your dog?*
How long have you had your dog?*  
Other Household Pets      
Species Sex Neutered/Spayed Age
Male Female Yes No
Male Female Yes No
Male Female Yes No
Medical History
We will need a copy of your most recent veterinarian vaccination records showing proof of Rabies vaccine, DHLPP (Distemper/Parvo) vaccine, Bordetella (Canine Cough) vaccine and a Fecal exam. You can fax this information to us at 914-218-8259, bring it with you when you come for your dog’s interview, or you can upload it now by clicking here.
(Note: Some devices may not allow you to select an attachment to upload.)
Type/Frequency of Flea/Tick preventive:*
Please list below any current or past medical problems/treatments or allergies:
Has your dog ever ...
Been to obedience class? Yes No Do not know
Been socialized to other dogs? Yes No Do not know
Jumped a fence? Yes No Do not know
Had to share food/water/toys with other dogs? Yes No Do not know
Growled at a person? Yes No Do not know
Growled at another dog? Yes No Do not know
Bitten a person? Yes No Do not know
Bitten another dog? Yes No Do not know
Other Information
What do you hope to achieve for you and your dog by utilizing our services?*
Is there anything else you would like to share with us about your dog?

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