Daycare Evaluation Form Chino Hills Pet Resort 3417 Chino Ave. Chino, CA 91710 909-464-9777 www.chinohillspetresort.comClient Name First Last Email Address: Address: Street Address Home PhoneWork PhoneCell PhonePatient Name:Age:Weight:Sex:Breed:Color:Day Care Evaluation QuestionsDate Date Format: MM slash DD slash YYYY Pet HistoryHow long have you had this pet?How did you obtain your pet?When was your pet altered (spayed or neutered)?Does your pet have any previous medical conditions (canine bloat, thyroid disease, coughing, or diarrhea)?Does your pet have any allergies?YesNoDoes your pet have any physical limitations (arthritis, blind, deaf)?Do you use any flea prevention?YesNoWhat type?When was it last applied?Does your pet live with another pet (dog or cat) or have they in the past?Do you take your pet to the Dog Park or Dog Beach? If so, how do they interact with other pets?How does your pet normally react to people they are unfamiliar with?How does your pet normally react to dogs they are unfamiliar with?Does your pet ever show aggression when guarding a toy?What type of training or showing experience does your pet have?Has your pet ever bitten another dog or person?YesNoIf yes, was medical attention needed?YesNoDescribe circumstancesHas your pet ever:Attended any dog Day Care or Doggie Camp?YesNoBoarded in a facility?YesNoDoes your pet jump fences?YesNoIs your pet kennel or crate trained?YesNoDoes your dog dig under fences?YesNoDoes your dog have experience sharing toys?YesNoCAPTCHA
