Naples - Preliminary Check In Form

1
First Name
Last Name
Pet's Name
Phone
Cell Phone
Alternate Cell Phone Number
2
* This field is required.
3
Where will you be staying?
Phone Number of where you are staying
Email
Local Emergency Contact Name
Local Emergency Contact Phone
4
About Your Pet
Please Select
Please Select
Frontline
Trifexis
Comfortis
Advantix
Advantage
Sentinel
Revolution
Other
What type of flea preventative is your pet using
Date of Last Application of Flea Preventative
Please Select
Please Select
Heartgard Chewable
Heartgard Non-Chewable Tablet
Sentinel
Interceptor
Revolution
Trifexis
What type of heartworm prevention is your pet using
Date of Last Dose of Heartworm Prevention
Please Select
Please Select
Yes
No
Would you like your pet to have a bath before going home
If yes, what day would you like them bathed ( We recommend the morning of departure.)
5
If they are chewers, there is a $33.00 fee for destroyed bedding. Please speak to our receptionist or kennel manager for other options.
Please Select
Please Select
Yes
No
Does your pet have long hair?
Please Select
Please Select
Yes
No
Can your pet use our bedding?
Please Select
Please Select
Yes
No
Has your pet had any coughing, sneezing, vomiting, or diarrhea recently
Please Select
Please Select
Yes
No
Has your pet or home had any problems with fleas or ticks recently
6
Is there anything special we should know about your pet (allergies, preferences, dog aggression, medical conditions)
7
Please Select
Please Select
Yes
No
Does your pet eat dry food?
Please Select
Please Select
We will bring our own food
My pet will enjoy Pedigree/ Science Diet provided by AMH of Naples
Food Choice (Dry)
Please Select
Please Select
None
1/4 Cup
1/2 Cup
1 Cup
1 1/2 Cup
2 Cup
How many MEASURED cups in the AM
Please Select
Please Select
None
1/4 Cup
1/2 Cup
1 Cup
1 1/2 Cup
2 Cup
How many MEASURED cups in the PM
Please Select
Please Select
Yes
No
Does your pet eat canned food?
Please Select
Please Select
We will bring our own food
We will purchase food from AMH of Naples at check-in
Food Choice (Wet)
Please Select
Please Select
1/4 Can
1/3 Can
1/2 Can
2/3 Can
3/4 Can
1 Can
How much in the AM
Please Select
Please Select
1/4 Can
1/3 Can
1/2 Can
2/3 Can
3/4 Can
1 Can
How much in the PM
8
Please Select
Please Select
Yes
No
Does your pet have any food allergies
Please Select
Please Select
Yes
No (none)
No ( will bring own treats)
Can your pet have treats (Milk Bones and Pup-peroni)
9
#1 MedicationLet us know how much is to be given, route of administration (by mouth, left eye, right ear, right elbow, etc.) and how many time per day.
Medication
Please Select
Please Select
Pill/Capsule
Oral Liquid
Powder on Food
Eye Drop/ Ointment
Ear Drop/ Ointment
Topical for Skin
Injection
Other
Form of Medication
Dosage
10
#2 MedicationLet us know how much is to be given, route of administration (by mouth, left eye, right ear, right elbow, etc.) and how many time per day.
Medication
Please Select
Please Select
Pill/Capsule
Oral Liquid
Powder on Food
Eye Drop/ Ointment
Ear Drop/ Ointment
Topical for Skin
Injection
Other
Form of Medication
Dosage
11
#3 MedicationLet us know how much is to be given, route of administration (by mouth, left eye, right ear, right elbow, etc.) and how many time per day.
Medication
Please Select
Please Select
Pill/Capsule
Oral Liquid
Powder on Food
Eye Drop/ Ointment
Ear Drop/ Ointment
Topical for Skin
Injection
Other
Form of Medication
Dosage
12
#4 MedicationLet us know how much is to be given, route of administration (by mouth, left eye, right ear, right elbow, etc.) and how many time per day.
Medication
Please Select
Please Select
Pill/Capsule
Oral Liquid
Powder on Food
Eye Drop/ Ointment
Ear Drop/ Ointment
Topical for Skin
Injection
Other
Form of Medication
Dosage
13
Extra Services
Exam by Doctor
Exam by Doctor
Toenail Trim
Microchip Implantation
Anal Gland Expression
Sanitary Cut
Shave Down
Medicated Baths
Dental Cleaning
Other Surgery
Yearly Exam and Vaccinations Updated if due with six weeks
-None_
Services I Would Like
Other
Please Select
Please Select
Once a day
Twice a day
None
Would you like private play times for your pet
14
Any special instructions not covered in this form
Should be Empty: