Day Care Client Questionnaire Client’s Name:*Date Phone*Email* Dog’s Name:Dog’s Age: Dog’s Breed: Date of Adoption:Is (dog’s name) spayed/ neutered intact?Most recent vet visit and results: Any current medical issues?YesNoCurrent on vaccinations? Current on Physical exam Rabies vaccine (rabies titers are NOT accepted) Distemper / parvo combination (or equivalent titer) Bordetella vaccine Canine influenza vaccines Leptospirosis vaccineAll dogs will be required to pass a temperament test prior to admission to day care.Dogs must be current on heartworm and flea prevention.All dogs must be spayed or neutered.All Vaccines must be complete 2 weeks prior to entry to day care or boarding to ensure adequate immunity, If you are a LePar client, we will review your dog’s vaccine records and contact you if any updates are needed.If you are not a current LePar client, please email us records at daycare@leparvet.net or provide us with the name of the clinic where your dog last received it's vaccines and we will contact themIf any updates are required, we will contact youPrevious Daycare ExperienceI have a series of questions to help me gauge our ability to provide the most appropriate and enjoyable stay and environment for (dog’s name).Has (dog’s name) ever gone to daycare before?YesNoIf yes:How did he respond?How did you feel about the experience?What lead you to look for a new daycare? If no:How do you expect (dog’s name) will respond to daycare?Do you have any concerns for (dog’s name) about attending daycare? Resource Guarding—DogsDoes (dog’s name) have any toys he prefers not to share with other dogs?YesNoIf yes, which toys?How does (dog’s name) respond when another dog approaches where she’s resting? What about when another dog approaches you?Does that change if you have food or treats?How does (dog’s name) let other dogs know he doesn’t want to share? Resource Guarding—HumansDoes (dog’s name) have any toys he prefers not to share with humans?YesNoIf yes, which toys?What does (dog’s name) do when a person reaches for something she has? How does (dog’s name) respond when a person approaches where she’s resting?What about when another person approaches you?Does that change if you have food or treats?How does (dog’s name) let people know he doesn’t want to share? Dog-Dog SocializationHow many dog friends does (dog’s name) have?ManyA fewOne or twoNoneHow often does (dog’s name) have a chance to meet new dogs?WeeklyOccasionallyRarelyWould you say that (dog’s name) warms up to new dogs:quicklyslowly upon first meetingover many meetingsneverWould you say that (dog’s name) is most comfortable:touching and interacting with other dogsbeing near but not interactingat a distancenot at allWhat does (dog’s name) do when he meets a new dog for the first time?Has (dog’s name) ever had an altercation with another dog?Tell me what happened.Dog PlayWhat kind of dog does (dog’s name) prefer to play with?Big dogsSmall dogsMid-size dogsOlder dogsYounger dogsRowdy/ energetic dogsLaid back dogsAre there any kind of dog (dog’s name) dislikes or prefers not to play with?Big dogsSmall dogsMid-size dogsOlder dogs Younger dogsRowdy/ energetic dogsLaid back dogsPuppiesBarrier FrustrationWhat does (dog’s name) do when she sees another dog while she’s on leash?What does (dog’s name) do when she sees another dog when she’s behind a fence or looking out through a window, such as at home or in the car?Dog- People RelationsWould you say that (dog’s name) warms up to new people:immediatelyquicklyover timeIs (dog’s name) comfortable having her collar put on and taken off?Loves itTolerates itHates itHow can you tell?Is (dog’s name) comfortable having her leash put on and taken off?Loves itTolerates itHates itHow can you tell?Is (dog’s name) comfortable being picked up, petted, and hugged?Loves itTolerates itHates itHow can you tell?Has (dog’s name) ever had bitten or snapped at a person?NoYesTell me what happened. PhoneThis field is for validation purposes and should be left unchanged.
