Dog Walking Intake Form Client InfoFirst Name *Last Name *Street Address *Apartment, suite, etc.City *Email Address *Phone *Emergency Contact Name & Phone *Is emergency contact allowed to make medical decisions *YesNoHome AccessHow will your home be accessed? *KeyLockboxKeypadSomeone will be homeWill alarm codes be required for entry? *YesNoIs there a special entry procedure I need to follow?YesNoPlease describe the entry procedure.Dog & Walking PlanDog Name *Dog Breed(s)Approximate Age (years) *Enter 0 for dogs under one year.Weight (lbs.) *Walking Instructions and Behavior NotesPlease tell me how and where you’d like your dog walked, including preferred routes, equipment, areas to avoid, and any triggers or reactions I should know about (e.g., other dogs, people, bicycles, cars, or wildlife).Behavior, Safety & HealthHas your dog ever bitten or injured a person or animal, or made contact that broke skin? *I ask so I can plan safe, low-stress walks and introductions. A “yes” does not automatically mean I cannot work with your dog.YesNoDate of most recent incident *Who was targeted? *Briefly describe what happened. *Does your dog guard food, toys, people, spaces, or other things? *YesNoWhat does your dog guard, how do they show it, and what should I avoid doing?Has your dog ever escaped, slipped out of a collar/harness, or bolted when being walked? *YesNoPlease describe what happened.Is there anything else about your dog's behavior that I should know before walking them?Please include any reactions to dogs, people, bicycles, cars, wildlife, or other situations.Does your dog have any health condition, medication, mobility limitation, or activity restriction that could affect walks or emergency care? *YesNoDescribe your dog's health condition(s) and treatment.Rabies Vaccine *I confirm that my dog is currently vaccinated against rabies, and I will notify Diana Dog Care if that status changes. Vet InformationPrimary Vet *Primary Vet Phone *Is your primary vet available for emergencies? *YesNoEmergency VetEmergency Vet PhoneIf both listed veterinarians are unavailable, may Diana Dog Care take your dog to the nearest open emergency vet and authorize necessary care? *YesNoDescribe any restrictions (e.g., where to go instead, spending cap). *Sign-offTerms of Service. *I have read and agree to the Diana Dog Care Dog Walking Terms of Service.SubmitPlease do not fill in this field.
