Reservations Questionnaire

Reservation Questionnaire

Welcome to the Golden Brook Farm Reservation Request Questionnaire. Please take some time to provide us with information abut yourself and your pet, so that we may be prepared as best as we can be in advance for your visit. NOTE: You must fill this form out for each dog. This form does not guarantee your reservation. We will contact you first to confirm your visit. Thanks for your cooperation!

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RESERVATION INFO

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Boarding Dates Requested Begin

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Boarding Dates Requested End

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Daycare Dates Requested Begin

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Daycare Dates Requested End

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OWNER INFO

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Your Name *

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Your Email *

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Mailing Address 1

Mailing Address 2

City

State or Province 2 Letter Abbreviation

Zip or Postal Code

Home Phone

Work Phone

Alternate Work Phone

Cell Phone

Alternate Cell Phone

Weekday Daytime Emergency Contact Phone

Weekday Evening Emergency Contact Phone

Weekend Daytime Emergency Contact Phone

Weekend Evening Emergency Contact Phone

How Did You Hear About Us?

If Search, what were Search Criteria (what you typed in to find us)? Please let us know any keywords you may have used to find us...

Did a person recommend us? If so,whom?

Did a Veterinarian Recommended Us? If so, whom?

DOG INFO

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Breed

Dog's Name *

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Approx. Date of Birth

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Sex Male Female

Approx. Weight

Spayed or Neutered? Yes No

If Yes, Age When Spayed Neutered?

Age When Acquired?

Where Did You Get Your Dog?

Has Your Dog Ever Been To A Daycare Boarding Facility Before? Yes No

If So, Did The Facility Have? Please check all that apply. Hold Ctrl to Select Multiple Items.

Was Your Dog Comfortable At The Daycare Boarding Facility? Yes No

Were You Happy With The Care They Provided? Yes No

If not, please explain:

TEMPERMENT & SOCIALIZATION INFO

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Does Your Dog Like To Play With? Please check all that apply. Hold Ctrl to Select Multiple Items.

To What Types Of Social Interaction Has Your Dog Been Exposed? Please check all that apply. Hold Ctrl to Select Multiple Items.

Is Your Dog Possessive Of Any Toys Food Or Objects? Yes No

If yes, please explain:

Has Your Dog Ever Growled Or Snapped At Anyone Taking Food Or Toys Away? Yes No

If yes, please explain:

Has Your Dog Ever Shared His Her Food Toys Or Bedding With Others? Yes No

What Types Of Toy sAre Your Dogs Favorite?

How Would You Describe Your Dog's Personality? Would you say your dog is more? Dominant Submissive

What Behaviors Have You Seen That May Exhibit This?

Are There Any Specific Dogs To Which Your Dog Reacts Negatively? Please check all that apply. Hold Ctrl to Select Multiple Items.

If specific breed, please explain:

Has Your Dog Ever Bitten Another Dog? Yes No

If yes, please explain:

Has Your Dog Ever Bitten A Person? Yes No

If yes, what were the circumstances under which that occurred?

How Does Your Dog React When Approached By Strangers At Home Or Yard Or Out In Public?

How Does Your Dog Respond To Other Dogs While On Leashed Walk? Do they respond to any of these while leashed? Please check all that apply. Hold Ctrl to Select Multiple Items.

If specific breed, please explain:

TRAINING INFO

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Name of Training Facitlity

Trainer Name

What Is Your Dogs Training History? Please check all that apply. Hold Ctrl to Select Multiple Items.

If private session, please explain

MEDICAL & BEHAVIORAL INFO

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Does Your Dog Have Any Allergies? Yes No

If so, please list:

Are There Any Kinds Of Food Or Treats That Your Dog Cannot Have? Yes No

If yes, please list:

What Kind Of Food Do You Feed Your Dog?

How Much Exercise Would You Say Your Dog Is Getting?

Does Your Dog Have Any Medical Problems Or Take Any Medications? Yes No

If so, please explain:

Does Your Dog Have Any Physical Problems Or Disabilities Which May Affect Them When Playing With Other Dogs? Yes No

If so, please explain:

Does Your Dog Need To Be Periodically Rested During The Day While At Our Facility? Yes No

If so, please explain:

Does Your Dog Have Any Kind Of Phobias/Fears? Yes No

If so, please explain:

Does Your Dog Exhibit Any Problem Barking Behaviors? Yes No

If so, what has been effective in quieting them down?

While At Home Does Your Dog Follow You From Room To Room? Yes No Sometimes