Intake Questionnaire

Please provide as much detail as possible for us to properly evaluate & price your inquiry. We will do our best to respond within 24-48 hours.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dog's Name

Dog's Age

Breed(s)

How long have you had your dog?

Was your dog rescued from a shelter? (If yes, please state when & where plus provide as much detail as possible)

Select

Veterinarian Name/Practice Name

Vet Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Vet Phone

(###)

###

####

Has your dog ever bit any animal or human?

Select

Has your dog ever been in a fight?

Select

Has your dog ever shown aggression towards other animals?

Select

Has your dog ever escaped your yard/home OR does it have a tendency to take off when off-leash?

Select

Does your dog have allergies or require medications? (If yes, please list & explain in detail the injuries/illnesses being treated)

Select

Has your dog been treated in the last 30 days with flea & tick medication?

Select

Is your dog fixed? (If not, and your dog is a female, when was her last heat cycle?)

Select

What is/are your primary goals for you and your dog?

Please select one or more below. If Other, please explain.

Any other important info you think we would find useful:

Intake Questionnaire

Hazard K9