Name *

First Name

Last Name

Phone *

(###)

###

####

Services of Interest (Check All That Apply): *

Canine Massage

Pet Sitting

Dog Walking

Sex *

Female

Male

Hair Length *

Long-haired

Short-haired

Activity Level *

Is Very Active

Is Inactive

Moderate Activity (30 mins daily exercise)

Has Experienced a Shift in Activity Level

General Health/Behavior (Check All That Apply): *

Exhibits Anxiety

Seems Stressed

Senior Pup

Active Puppy

Currently Injured

Behavior Issues

Special Needs

Sensitive Areas

Takes Medication

Has Allergies

Has Genetic or Age Related Ailments

Is Currently Undergoing Treatment

NONE OF THE ABOVE

Fears/Phobias

Is fearful of loud unexpected sounds (sirens, fireworks)

Unfavorable reaction to strangers or family members

Is fearful of other dogs or animals

Exhibits separation anxiety behaviors

Is stressed over novel items, new experiences or places