Hours:  Monday - Sunday    7-days a week     8:00 a.m. to 6:00 p.m.      Contact Information:       (507)645-4669 - Local       (507) 271-8559 - Cell      (507) 271-8459 - Cell     (507) 645-6328 - Fax ptfe body jewelry

CLIENT INFORMATION The form below is to ensure that we know as much about your pet(s) as possible. This will allow your pet to have the safest and BEST time possible at Countryside Kennel. gold cz earrings

Please print out and fill out this form. Bring the completed form with you when you drop off your pet/s. buy research paper online

Any special medications, treatments, allergies, or other health issues (e.g. hip dysphasia, hotspots)?: Does your pet suffer from seizures? (Please circle response)    Yes    No If so, what type of medication does your pet take? ______________________________ How often? _____________________________________ How much and is it pill, liquid or shot form? ___________________________________ Is your pet diabetic? (Please circle response)   Yes   No If diabetic, how often do they get their shots? _______________________ At what time of day should they get their shot? _______a.m. _______p.m. How many units of insulin per shot?_________ Has your pet suffered from any communicable diseases in the last 30 days?    Yes    No If yes, please explain: Do you consider your pet social with other pets? Has your pet ever bitten a person?     Note: If your pet bites another pet/person at Countryside Kennel, you will be held liable. Is your dog escape oriented?    Does your pet do any of the following: a) Dig?   Yes   No b) Chew bedding?   Yes   No c) Climb/jump?   Yes   No Has your dog ever been boarded at a kennel before?     Yes      No If so, were there any problems that you were aware of? Does your dog suffer from separation anxiety?    Yes    No Is you pet afraid of thunder/lighting storms or rain storms?    Yes    No If so, would you give us permission to administer a calming medication at our discretion until they are adjusted to the environment?     Yes    No Would you like your dog to have any grooming services while at the kennel?    Yes     No If so, please circle which service you would like to have done: Nails      Ears      Bath      Full Groom (all 3 services at a price reduction of $2.00) How did you hear about us? What is your e-mail address?    (Be assured that your e-mail will only be used for kennel business.) I have read, understand, and provided all the information above to the best of my knowledge. Name of pet:   Client Signature: _________________________________       Date:____________