Double Dog Ranch

Lorinda Gayl / Sam Sevier

416 South Francisca Avenue

Redondo Beach, CA 90277

310-316-1133

Double Dog Ranch Customer Input Form

Last Name

First Name

Address 1

Address 2

City

State

Zip

Home Phone

Business Phone

Cell Phone

Pager

E-mail address

Local Emergency Contact

Veterinarian Name and Phone

Animal Health Insurance

Yes No

Dog Evaluation Questionnaire

1- How often has/have your dog(s) visited a dog park?

Dogs have parks?

Once or twice

Weekly

My dog has a reserved parking place

2- Has/have your dog(s) ever behaved agressively toward other dogs in the park?

3- Have other dogs ever been aggressive toward your dog(s)?

Yes

No

4- If yes, what were the circumstances? Were there any injuries? Please explain.

5- Has/have your dog(s) attended doggie day care? How frequently? Any problems?

6- If your dog(s) has/have been left overnight it was at: (check all that apply)

Own home

Vet's office or commercial kennel

Daycare facility

Friend's house

Were there any behavioral problems either while you were away or upon your return? If so, what were they?

Does/do your dog(s) try to dominate other dogs, in play or otherwise?

Yes

No

Is/Are your dog(s) submissive, rolling over on its back a lot when playing or otherwise?

Yes

No

In your opinion what would provoke your dog(s) to bite another dog?

Is/Are your dog(s) toy possessive (not sharing toys with other dogs)? If so, what would she/he do if another dog wants to play with the toy?

When you leave your dog(s) at home or anywhere else he/she:

Has/Have your dog(s) ever run away for any reason whatsoever (chasing cat, dog, looking for you, etc.)? If so, how many times, and in your opinion, what was the reason?

How does/do your dog(s) behave around adult strangers?

Has/Have your dog(s) been exposed to (check all that apply)

Babies and toddlers

Small children

Adolescents

Any problems at day care? Please explain

How does/do your dog(s) generally behave around other dogs?

Does his/her behavior depend on the size, breed or gender of other dogs? Please explain.

When walking on leash and you encounter another dog, your dog:

When given the "come" command, your dog(s)

Has/Have your dog(s) ever bitten anyone including you? What in your opinion was the reason?

In our opinion what would provoke your dog(s) to bite someone?

Under what circumstances does/do your dog(s) bark?

What kind of general physical condition is/are your dog(s) in?

Dog Information Form (One for each dog)

Owner Name

Dog Name

Breed

Description / Color

DOB / Age

Licensed

Yes No

Spayed / Neutered

Yes No

Tattoo / MicroChip Details

Flea & Tick Program (both required)

Yes No

Feeding / Medication Instructions

Food Brand / Type

Pet Habits / Idiosyncrasies / Allergies / Additional Information

   
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