Doggy Intake Form

If you have had your home visit and we have agreed that you will board your dog(s) with me, please fill out the form below.

Owner Information
Name*
First Last
Co-Owner Name (if applicable)
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Cell Phone*
Land Line
At your home, are dogs allowed on the furniture?
- No
- The dogs have some furniture they are allowed on
- The dogs are allowed on all furniture
How often would you like to receive updates on your dog(s)?
- Once a day
- Throughout the day
- Every few days
- Don't notify me
How would you prefer to be notified?
- By email
- By text
Emergency Gardianship
If for some reason you are unable to return to pick up your pet at the agreed upon date, please list who should be given custody of your dog(s) if it is not practicle for them to extend their stay with me.
Veterinary Information
Veterinary Practice*
Please fill in the name of the veterinary practice that sees your pets.
Vets Name*
What is the name of your vet?
First Last
Vet's Phone Number*
Please fill in your vet's phone number
Medical Release Authorization*
I give Heather Goff my express permission to take my dog(s) to the above-mentioned veterinarian (or to the closest open facility if the primary vet is not available). I give permission for the veterinarian to administer any care or medications necessary. I will assume full responsibility for the payment for any and all veterinary services provided.
- I agree
House Treats
I sometimes give my dogs thick bully sticks and/or beef trachea (purchased from bestbullysticks.com). These are all natural, single ingredient, organic beef parts. Please let me know if it is okay for your dog(s) to enjoy these treats.
- It is okay for my dog to chew on a thick bully stick
- It is okay for my dog to chew on a beef trachea
Dog Information
Name of Dog*
Breed*
Weight*
Age*
Feeding Schedule*
Please explain what brand of food you feed this dog, how much, and their feeding schedule. Please be specific about the hours(s) that you feed your dog. Will they be expecting to eat dinner at 3pm (for example) or 5pm.
Allergies
Please specify if this dog has allergies to certain foods, to wool etc.
Outdoor Schedule*
Please explain your dog's schedule for going outside. What times do they expect to be put out, and how often. Please be specific about the exact time that your dog is used to going out. For example, in the morning, do they go out at 6am? or 7:30am?
Please take this dog on your daily walks
- No, don't walk my dog. They should stay in the house and the yard.
- Yes, please walk my dog with your pack.
House Training*
Please select all that apply
- This dog is house trained
- This dog is crate trained
- This dog is trained to use indoor pads
- This dog wears a belly band
- This dog is not house trained
Behavior*
Please select all that apply
- This dog likes other dogs
- This dog is a loner
- This dog is protective of their food
- This dog is protective of their toys
- This dog gets anxious if left alone
- This dog might mark their territory in the house
- If walked off leash, this dog will run away
- This dog does not like to be touched
- This dog enjoys being pet
- This dog is nervous around children
- This dog needs a lot of exercise
- This dog has trouble going up or down stair cases
Fears and Phobias
I want your dog's visit to be as stress free as possible. Please describe anything that spooks, scares or triggers fear in your dog. For example, thunder, sudden loud noises, large men, squeaky door hinges...
Medical
If this dog requires medication, please explain what they take and the dosage.
Grooming
Does this dog require brushing and/or bathing, and/or the application of topical skin creams and if so, how often?
Sleeping Habits*
Where does this dog like to sleep when they are home?
More Details
Please let me know any other details about this dog that will make their stay at my home more enjoyable.
Add a second dog?
- Yes, add a second dog
Second Dog
Name of Dog*
Breed*
Weight*
Age*
Feeding Schedule*
Please explain what brand of food you feed this dog, how much, and their feeding schedule. Please be specific about the hours(s) that you feed your dog. Will they be expecting to eat dinner at 3pm (for example) or 5pm.
Allergies
Please specify if this dog has allergies to certain foods, to wool etc.
Outdoor Schedule*
Please explain your dog's schedule for going outside. What times do they expect to be put out, and how often. Please be specific about the exact time that your dog is used to going out. For example, in the morning, do they go out at 6am? or 7:30am?
Please take this dog on your daily walks
- No, don't walk my dog. They should stay in the house and the yard.
- Yes, please walk my dog with your pack.
House Training*
Please select all that apply
- This dog is house trained
- This dog is crate trained
- This dog is trained to use indoor pads
- This dog wears a belly band
- This dog is not house trained
Behavior*
Please select all that apply
- This dog likes other dogs
- This dog is a loner
- This dog is protective of their food
- This dog is protective of their toys
- This dog gets anxious if left alone
- This dog might mark their territory in the house
- If walked off leash, this dog will run away
- This dog has trouble with stairs
- This dog needs a lot of exercise
- This dog is nervous around children
- This dog does not like to be touched
- This dog enjoys being pet
Fears and Phobias
I want your dog's visit to be as stress free as possible. Please describe anything that spooks, scares or triggers fear in your dog. For example, thunder, sudden loud noises, large men, squeaky door hinges...
Medical
If this dog requires medication, please explain what they take and the dosage.
Grooming
Does this dog require brushing and/or bathing and if so, how often?
Sleeping Habits*
Where does this dog like to sleep when they are home?
More Details
Please let me know any other details about this dog that will make their stay at my home more enjoyable.
Add a third dog?
- Yes, add a third dog
Third Dog
Name of Dog*
Breed*
Weight*
Age*
Feeding Schedule*
Please explain what brand of food you feed this dog, how much, and their feeding schedule. Please be specific about the hour(s) that you feed your dog.
Allergies
Please specify if this dog has allergies to certain foods, to wool etc.
Outdoor Schedule*
Please explain if your dog's schedule for going outside. What times do they expect to be put out, and how often. Please be specific about the exact time that your dog is used to going out. For example, in the morning, do they go out at 6am? or 7:30am?
Please take this dog on your daily walks
- No, don't walk my dog. They should stay in the house and the yard.
- Yes, please walk my dog with your pack.
House Training*
Please select all that apply
- This dog is house trained
- This dog is crate trained
- This dog is trained to use indoor pads
- This dog wears a belly band
- This dog is not house trained
Behavior*
Please select all that apply
- This dog likes other dogs
- This dog is a loner
- This dog is protective of their food
- This dog is protective of their toys
- This dog gets anxious if left alone
- This dog might mark their territory in the house
- If walked off leash, this dog will run away
- This dog needs a lot of exercise
- This dog is nervous around children
- This dog does not like to be touched
- This dog enjoys being pet
- This dog has trouble with stairs
Fears and Phobias
I want your dog's visit to be as stress free as possible. Please describe anything that spooks, scares or triggers fear in your dog. For example, thunder, sudden loud noises, large men, squeaky door hinges...
Medical
If this dog requires medication, please explain what they take and the dosage.
Grooming
Does this dog require brushing and/or bathing and if so, how often?
Sleeping Habits*
Where does this dog like to sleep when they are home?
More Details
Please let me know any other details about this dog that will make their stay at my home more enjoyable.
Release of Liability
Release of Liability
I entrust Heather Goff to use her best judgment in caring for my dog(s), including arranging for a backup dog sitter if necessary. I agree to hold Heather Goff harmless for consequences related to such decisions. I understand that animals are unpredictable and that Heather Goff cannot be held responsible for mishaps to my dog(s) including, but not limited to, any dog(s)’s refusal to take medication, escaping, biting, or ingestion of foreign materials resulting in injury or accidental death. I understand that in the event of inclement weather, natural disaster, or emergency, Heather Goff is entrusted to use her best judgment in caring for my dog(s) and shall not be held responsible for consequences related to any of her decisions. I agree that I shall be solely responsible for any and all acts of and behavior of my dog(s) while in the care of Heather Goff. This includes, but is not limited to injury to other animals or persons caused by my dog(s). Should my dog(s) bite or otherwise injure someone, Heather Goff shall not be help liable for any costs that are incurred.
- I agree
Signature*
The information that I have filled out about my dogs is correct to the best of my knowlege and I understand that when I click the submit button, I am digitally signing this form.
- I understand
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Doggy Intake Form

Owner Information

Veterinary Information

Dog Information

Second Dog

Third Dog

Release of Liability