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2017-02-02T18:57:13-08:00
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Cook Islands
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Kenya
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Korea, Republic of
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Libya
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Nauru
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New Caledonia
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Niger
Nigeria
Niue
Norfolk Island
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Panama
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Réunion
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Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
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Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
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Sudan
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Switzerland
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Thailand
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*
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Last
Clinic
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Algeria
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Armenia
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Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
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Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
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Tunisia
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Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
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Uruguay
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Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
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Zimbabwe
Åland Islands
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Fax
Email
Pet Information
Name
*
Breed
*
Sex
*
Male
Female
Spayed or Neutered?:
*
Yes
No
Age
*
Date of Birth
Vaccination Information
Rabies: (every 3 years)
*
Enter Month and Year
DHLPP: (every 2 years)
*
Enter Month and Year
Feeding Information
What does your dog eat?
*
Time fed
*
Amount of food in AM:
*
Amount of food in PM:
*
Does your dog have any un usual eating habits? If so, briefly describe:
Health and Grooming
Does your dog have any medical conditions? If so, briefly describe:
Does your dog have any hip dysplasia or arthritis? If so, please explain any restrictions on activities:
Does your dog have any allergies?
Does your dog have a problem with fleas?
Does your dog like being brushed?
Does your dog’s coat require frequent brushing?
How does your dog react to having his nails trimmed?
How does your dog react to bathing?
If you use a groomer regularly, please list name and phone number.
Behavior Information
Are there any kinds of dogs your dog fears or dislikes? If so, briefly describe:
*
Has your dog ever growled at someone? If so, what were the circumstances?
*
Has your dog ever bitten someone? If so, what were the circumstances?
*
Does your dog ever climb or jump out of fenced areas?
*
Where is your dog when you are not at home?
*
Does your dog have any problems in the following areas?
Select all that apply
Mouthiness
House training
Barking
Digging
Running away from you
Jumping over fences to get out
If so, briefly describe:
Does your dog have any food or toy possessiveness? If so, briefly describe:
Does your dog play with other dogs?
Yes
No
What kind of collar do you use when you walk your dog?
*
Please list any additional behavioral traits that you feel are important for us to know.
Do you have a second dog to add?
*
Yes
No
Pet Information (Dog Number 2)
Name
*
Breed
*
Sex
*
Male
Female
Spayed or Neutered?:
*
Yes
No
Age
*
Date of Birth
Vaccination Information
Rabies: (every 3 years)
*
Enter Month and Year
DHLPP: (every 2 years)
*
Enter Month and Year
Feeding Information
What does your dog eat?
*
Time fed
*
Amount of food in AM:
*
Amount of food in PM:
*
Does your dog have any un usual eating habits? If so, briefly describe:
Health and Grooming
Does your dog have any medical conditions? If so, briefly describe:
Does your dog have any hip dysplasia or arthritis? If so, please explain any restrictions on activities:
Does your dog have any allergies?
Does your dog have a problem with fleas?
Does your dog like being brushed?
Does your dog’s coat require frequent brushing?
How does your dog react to having his nails trimmed?
How does your dog react to bathing?
If you use a groomer regularly, please list name and phone number.
Behavior Information
Are there any kinds of dogs your dog fears or dislikes? If so, briefly describe:
*
Has your dog ever growled at someone? If so, what were the circumstances?
*
Has your dog ever bitten someone? If so, what were the circumstances?
*
Does your dog ever climb or jump out of fenced areas?
*
Where is your dog when you are not at home?
*
Does your dog have any problems in the following areas?
Select all that apply
Mouthiness
House training
Barking
Digging
Running away from you
Jumping over fences to get out
If so, briefly describe:
Does your dog have any food or toy possessiveness? If so, briefly describe:
Does your dog play with other dogs?
Yes
No
What kind of collar do you use when you walk your dog?
*
Please list any additional behavioral traits that you feel are important for us to know.
Phone
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