Address: ____________________________________________________________________________________

 

                    Home Phone: ______________________Cell Phone: _____________________Other: ______________________

                    E-mail address _______________________________________________________________________________

                    Do you qualify for:     Active Military Discount  ___     Senior Citizen Discount (60 yrs + older)  ___     Cat Spots  ___

                    How did you hear about University Pet Resort?

              Newspaper  ___     Radio ___     Vet.  ___     TV  ___     Phone Book  ___     Internet  ___     Other:_____________________

 

            Breed: ______________________ Color: ______________________   Date Of Birth: _______________    

    Sex?  Female  ___     Male  ___     Spayed/Neutered?  yes  ___     no  ___

 1.       Food    Type: Use UPR’s food  ___     I brought my own food ___

Instructions: _________________________________________________________

 2.       Medication- Please request a Medication Form

 3.        Medical History  Your pet’s vet? ______________________ Date of last visit? __________

        Are you aware of any health problems or physical pain your pet may be experiencing?

          yes  ___     no  ___ If yes, please describe 

       ________________________________________________________________________________________

       4,    Personality Profile

 Does your dog have any sensitive areas on his/her body?    __________________________________________________________________________________

          Does your pet jump or climb fences?    yes  ___     no  ___        Does your dog dig or chew?   yes  ___     no  ___

 How old was your pet when he/she was spayed/neutered?  ___________________________________

 

 Under what circumstances has your dog interacted with other dogs? 

________________________________________________________________________________________________

 

          Has your dog ever displayed aggression towards a person/other dog?    yes  ___     no  ___

 If yes, what were the circumstances?

_________________________________________________________________________________________________

          Are there any kinds of people or dogs your dog automatically fears or dislikes?  yes  ___     no  ___

 If yes, please describe:

__________________________________________________________________________________________________

 

                                                   If you have questions or concerns please let us know.