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Clinic clients who sign up for a wellness plan receive 5-10% off resort and grooming services. learn more

Home » New Dog General Questionnaire

New Dog General Questionnaire

All dogs over 6 months of age must be spayed or neutered to participate in group play. Intact dogs under the indicated age will be able to play in our puppy groups.

Client Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Dog's Name(Required)

Breed/Mix(Required)

Sex(Required)

Age(Required)

Date of Birth(Required)

MM slash DD slash YYYY

General Dog Information

How long have you owned your dog?(Required)

Is your dog spayed or neutered?(Required)

Yes

No

If yes, when were they fixed?(Required)

If no, when was their last heat (female only)

Are there any medical conditions/injuries/physical limitations we should be aware of?(Required)

Yes

No

If yes, please describe(Required)

Does your dog have any allergies?(Required)

Yes

No

If yes, to what are they allergic to?(Required)

May we give your dog treats?(Required)

Yes

No

Does your dog suffer from any separation anxieties?(Required)

Yes

No

If yes, would this affect your pet while boarding or being in a kennel?(Required)

Yes

No

If yes, please describe(Required)

Does your dog ever suffer from periodic diarrhea?(Required)

Yes

No

If yes, please describe the circumstances(Required)

Has your dog received a diagnosis for it?(Required)

Yes

No

Is your dog on medication for the diarrhea?(Required)

Yes

No

If yes to either question, please describe(Required)

Has your dog ever chewed on or ingested a blanket, sock, toy or other type of non-food item while unsupervised?(Required)

Yes

No

If yes, please describe the circumstances(Required)

Does your dog display any type of barrier aggression? (Kennel aggression, fence fighting, barking at dogs on the other side)?(Required)

Yes

No

If yes, please describe the circumstances(Required)

Has your dog ever jumped a fence?(Required)

Yes

No

If yes, type and height of fence(Required)

Has your dog ever dug underneath a fence?(Required)

Yes

No

Has your dog ever shown aggression towards someone?(Required)

Yes

No

If yes, please describe the situation(s)?(Required)

Has your dog ever bitten a person?(Required)

Yes

No

Please describe the circumstances(Required)

Has your dog ever bitten another dog?(Required)

Yes

No

Please describe the circumstances(Required)

Does your dog have any obedience training?(Required)

None

Self-trained

Formal Classes

How well does your dog respond to obedience cues?(Required)

Rarely

Occasionally

Consistently

Please indicate any of the following behaviors or issues you have with your dog: Check all that apply

Dominant in Play

Chasing

Not Coming When Called

Fence Fighting

Mouthing

Dog Aggression

Fear of Storms

Mounting

Submissive in Play

Pulling on Leash

Showing Teeth

Nipping

People Aggression

Fear Aggression

Digging

Submissive Urination

Escaping

Excessive Licking

Snapping

Food Guarding

Separation Issues

Chewing

Excited Urination

Lunging

Stool Eating

Biting

Toy Guarding

Shyness

Barking

Marking

Charging

Separation Anxiety

Growling

Territorial Guarding

Fear of Noises

Is there anything else you would like us to know about your dog?

Would you like more information about any of the other services offered at BloomingPaws?

Nutrition

Grooming

Boarding

Daycare

Veterinary Clinic

Group Play Questions Only

How would you describe your dog's energy level?(Required)

Low

Medium

High

Has your dog ever chased a small animal, such as a cat, squirrel, rabbit or smaller dog?(Required)

Yes

No

How would you describe your dog's level of socialization with other dogs?(Required)

None

Moderate

Extensive

Why are you considering off leash play for your dog?(Required)

Play with other dogs

So not home alone

Socialization

Exercise

Has your dog ever been to a daycare or dog park?(Required)

Yes

No

If yes, please describe your dog’s behavior and play style with other dogs(Required)

Client Signature(Required)

Δ

BloomingPaws is a premier, full-service pet care facility in Bloomington, IN. Since 1993 we have aimed to provide outstanding service for our clients and their pets by treating them all with love, compassion, and respect.

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address

3409 S Walnut St
Bloomington, IN 47401

contact

Vet Services

812-333-2273 (select option 2)
clinic-cust-service@bloomingpaws.net

Resort & Spa Services

812-330-7297 (select option 1)
customerservice@bloomingpaws.net

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