Dog Lifestyle Questionnaire Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Owner's Name *Pet's Name *PhoneEmail *How many other pets in household? (number and type of pet) *Where do your pets spend the majority of it's time? *Select one...IndoorsOutdoorsWhere does your dog sleep at night? *Is your dog microchipped? *Select one...YesNoUnsureDo you give monthly preventatives? *Select one...YesNoIf NO, would you like it done today? *Select one...YesNoUndecidedBrand of Preventative *Select one...Simparica TrioSentinelNexgardFrontlineAdvantixOtherWhen did you give the last dose? *Is it easy to give? *YesNoWhere do you purchase your preventatives? *Do you need any refills today? *Select one...YesNoDoes your dog have any accidents in the house? *Select one...YesNoI don't knowWhat kind of accidents? *Select one...UrinaryBowel MovementsBothNoneDoes your dog spend any of their time: *At the GroomerPlaying with ChildrenAt Dog ParksDoggie Day CareTravelingHuntingNone of the aboveHow would you describe your dog’s attitude? *HappyAggressiveDepressedNervous / AnxiousIs your dog on any other medications? If yes, please list below: *Your dog’s diet consists of: *Commercial Pet Food (Brand)Home-Cooked Meals (Provide Example)Some Table Food (Provide Example)Other (Provide Example)Provide example: * house? done the Do you have children or immunocompromised people in your household? *Select one...YesNoAny questions concerning your dog’s lifestyle or vaccine schedule?Submit
