Willow's Walkies
Welcome
Contact
Instagram
Welcome
Contact
Willow's Walkies
Instagram
Willow’s Walkies Consultation Form
General Information
Name
*
First Name
Last Name
Email
*
Phone Number
*
Full Address
*
Partner's Name
Partner's Phone Number
Vet's Name
*
Vet's Address
*
Vet's Emergency Number
*
Security Information
Gate Codes (If Needed)
Alarm Instructions (If Needed)
Your Dog's Details
Dog's Name
*
First Name
Last Name
Dog's Age
*
Dog's Gender
*
Breed
*
Colour
*
Is Your Dog Microchipped
*
Yes
No
Is Your Dog Insured?
*
Yes
No
How long have you owned your dog?
*
Please briefly describe your dog’s history (e.g. if adopted)
*
Date of last immunisation
*
Neutered?
*
Yes No No but will be by..
Un-Neutered Bitch? Date of Last Season?
*
Up to date with vaccinations/boosters?
*
Yes
No
No but will be by..
Date of last Kennel Cough vaccination (Bordetella)?
*
Allergies?
*
Please list any pre-existing or current health conditions.
*
Please list any medication your dog is currently taking and instructions.
*
Please indicate if your dog has sensitive areas on his or her body.
*
Please describe any restrictions on your dogs activity (e.g. due to physical limitations such as dysplasia)
*
Is your dog allowed treats whilst in my care?
*
Social Skills
Please give brief description of any formal obedience training your dog has received.
*
How does your dog react to other people and dogs when on walks?
*
Behaviour
Please describe general behaviour and energy levels (both inside and when out)
*
Please provide details if your dog is anxious around, or frightened by, any of the following:
*
Not Anxious at all
Noises
Actions
Objects
Breeds or Types of Dog
People
Does your dog ever get car sick?
*
Does your dog have specific command to "go to the toilet"?
*
Does your dog behave differently on and off lead?
*
Does your dog play off lead with other dogs?
*
Does your dog live with children?
*
How does your dog behave around new children?
*
How does your dog behave around livestock?
*
Has your dog ever jumped on someone (if so, please describe the circumstances)?
*
Has your dog growled or snarled at someone (if so, please describe the circumstances)?
*
Has your dog ever bitten someone (if so, please describe the circumstances)?
*
Has your dog ever bitten another dog, other than play-biting (if so, please describe the circumstances)?
*
Does your dog allow you to take things out of his/her mouth?
*
What type of dogs does your dog prefer to socialise with (e.g., small, females, playful, calm, etc.)?
*
Will they chase:
*
Doesn’t Chase
Cats
Deer
Livestock
Small Animals
Off Lead with Owner:
*
Yes - Always
Usually
Occasionally
Never
Recall:
*
Very Good
Average
Poor
Any extra info we should know?
*
Type of Lead:
*
Standard
Extendable
Type of Restraint:
*
Full check
Half Check
Standard Collar
Gentle Leader
Halter
Harness
Muzzle
Other
Routine
Please describe pick up and return routine
*
Please give any other information that you think would be useful to enable me to give your dog the best possible care while under the care of Willow’s Walkies.
*
Disclaimer - The information I have given in this application is true, correct and complete to the best of my knowledge.
Full Name
*
First Name
Last Name
Date
Thank you for completing your Consultation Form!
