Client Intake Form | THE FARMER'S DAUGHT

top of page

Home
About
Services
- Client Intake Form
Contact
More

Use tab to navigate through the menu items.

THE FARMER'S DAUGHTER CLIENT INTAKE FORM

Please fill out a separate form for each pet

CLIENT INFORMATION

Owner Name(s)

Phone

Phone 2

Address

Emergency Contact

Emergency Contact Phone

PET INFORMATION

Pet Name

Breed

Date of Birth

Weight

Spayed or Neutered

Yes

Gender

Male

Female

Age

PET PROFILE

Is your dog generally people/kid friendly?

Yes

Is your dog generally friendly to other dogs?

Yes

Is your dog ok to be included in group/pack play?

Yes

Is your dog easily frightened by thunder/fireworks/loud noises?

Yes

Does your dog climb fences or try to escape from enclosed areas?

Yes

Does your dog have separation anxiety or other anxiety issues?

Yes

What should we know about your dog's behaviors?

FEEDING INSTRUCTIONS

Brand of Dog Food

Amount of Food in Morning and Evening

MEDICAL INFORMATION

All dogs are required to show proof of Rabies/DHLPP/Bordetella vaccinations. Please upload vet/immunization records or email to tiffany@farmersdaughterpetresort.com 2 weeks prior to stay.

Veterinary Office

Medications/Dosage

Upload Vet Records Here

Date

Month

Day

Year

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Contact Us

THE FARMER'S DAUGHTER USA, LLC

N6409 Fair Haven Ave

Chili, WI 54420

715-897-5759

tiffany@farmersdaughterpetresort.com

Drop-off / Pick-up times:

Monday-Friday: 7:30-9:00am, 3:00-5:00pm

(no Friday pm hours during high school football season)

Saturday: 8:00-9:00am

Sunday: 4:00-5:00pm

bottom of page