When is your orientation day appointment?  *   About Your Dog Dog's Name:  * Breed or Description:  *   Health & Behavior History Birthdate or Approximate Age:  *   Please Select One: Neutered Male Spayed Female Non-neutered male under 8 months Non-spayed female under 8 months   Please Check all Boxes that Apply to Your Dog: If my dog needed to be kenneled for a medical or behavior reason he might chew up or ingest pieces of a dog bed Please do not use any scented grooming products on my dog while he is at Woof Dah! My dog is prone to diarrhea vomiting or has a sensitive stomach My dog should not eat our home-made birthday cake (ingredients include hamburger rice peanut butter and Milk Bones) My dog has been aggressive with another dog My dog has been aggressive while greeting another dog on a leash My dog has been aggressive over food or toys My dog has been aggressive towards a person My dog has bitten another dog or a person Please provide details (if appropriate) for any of the boxes you checked above   Describe any health conditions your dog has or has had in the past. Any allergies to medications foods or insects? Anything else we should know about best caring for your dog? Regular Veterinary Clinic: Clinic phone number:   Owner's Contact Information First Name:  * Last Name:  * Street Address:  * City State and Zip  * Best phone number to reach me at on orientation day is:  * Home phone number:  * Work phone number: Cell phone number: Last 4 digits of your Drivers License number  * This is a required security code that allows you to add or change information on this form via email or phone such as adding a person you want to be authorized to pick up your dog.   Additional Contact Person(s): Spouse / Friend / Family Member (Strongly Recommended) Their First Name: Their Last Name: This person is a: Friend Relative Significant Other Spouse This person is: Not an owner of the dog Also an owner of the dog Their home phone number: Their work phone number: Their cell phone number: In addition to myself and my 2nd contact person the following persons are authorized to pick up my dog. (A photo ID may be required)   Your dog will receive a complimentary ID collar for Orientation Day. Please select the colors you like best below: Collar Color Choices Please select one:* Denotes staff favorites :-)Red Collar with Black LetteringRed Collar with Silver LetteringRed Collar with Purple LetteringRed Collar with White LetteringRed Collar with Gold LetteringRed Collar with Blue Lettering*Hot Pink Collar with White LetteringHot Pink Collar with Black LetteringHot Pink Collar with Bright Green Lettering*Hot Pink Collar with Silver LetteringHot Pink Collar with Gold LetteringHot Pink Collar with Purple LetteringHot Pink Collar with Blue LetteringHot Green Collar with Black Lettering Hot Green Collar with Silver LetteringHot Green Collar with Gold LetteringHot Green Collar with Blue LetteringHot Green Collar with Purple Lettering*Hot Green Collar with Hot Pink Lettering*Hot Green Collar with White LetteringHunter Green Collar with White LetteringHunter Green Collar with Gold Lettering*Hunter Green Collar with Silver LetteringTurquoise Collar with Gold LetteringTurquoise Collar with Black LetteringTurquoise Collar with White LetteringTurquoise Collar with Purple Lettering*Turquoise Collar with Hot Pink Lettering*Blue Collar with Red Lettering*Blue Collar with White LetteringBlue Collar with Bright Green LetteringBlue Collar with Hot Pink LetteringBlue Collar with Silver LetteringBlue Collar with Gold LetteringPurple Collar with White LetteringPurple Collar with Red LetteringPurple Collar with Gold Lettering*Purple Collar with Hot Pink Lettering*Purple Collar with Bright Green LetteringPurple Collar with Silver LetteringPurple Collar with Blue Lettering*Black Collar with Silver LetteringBlack Collar with Blue LetteringBlack Collar with White LetteringBlack Collar with Bright Green LetteringBlack Collar with Purple LetteringBlack Collar with Red LetteringBlack Collar with Gold LetteringBlack Collar with Hot Pink Lettering*I would like to choose when I arrive.I would prefer to order an embroidered collar for $7 when I arrive.   How did you find out about us? Please select one:Referral Internet SearchDex Phone BookYellow Book Phone BookDex OnlineYellow Book OnlineAngie's ListEagan Pet ClinicOther Veterinary ClinicShelter or Adoption GroupOther Your email address:  * Comments or Questions about this form: Thank You! Security code:   * Do not enter anything in this field: