First Name:

Last Name:

E-mail:

Street address + Post Code (for invoice purposes)

Name & Nicknames? (Dog's)

Age?

Breed? (or best guest if unknown)

Sex? Sex? Male Female

De-sexed? (Spayed/Castrated) De-sexed? (Spayed/Castrated) Yes No

Weight in Kgs? (or best guess if unknown)

Any known allergies? (food, etc.) Any known allergies? (food, etc.) Yes No

Please explain:

Any known illnesses? (diabetes, epilepsy, hyperthyroidism, etc) and medical history (operations, etc.) Any known illnesses? (diabetes, epilepsy, hyperthyroidism, etc) and medical history (operations, etc.) Yes No

Please explain:

Any known ailments?, past or current injuries (limping, bad paws etc.) Any known ailments?, past or current injuries (limping, bad paws etc.) Yes No

Please explain:

Any medication? Any medication? Yes No

Please tell us the name of the medication, the dosage and how often it is administered.

Are Flea and Tick/deworming treatments up to date? (We live in a low population tick area, but we regularly go on walks and hikes in the forest) Are Flea and Tick/deworming treatments up to date? (We live in a low population tick area, but we regularly go on walks and hikes in the forest) Yes No

Are all vaccinations up to date? Please e-mail a picture/scan of the passport/vaccination book information page (the one with the name and microchip number) + latest vaccination page to info@3dognight.fi. Alternatively you can send the picture to +358 46 881 5877 Are all vaccinations up to date? Please e-mail a picture/scan of the passport/vaccination book information page (the one with the name and microchip number) + latest vaccination page to info@3dognight.fi. Alternatively you can send the picture to +358 46 881 5877 Yes No

General behaviour with other dogs and people?

Feeding schedule (how much?, how often? and when?)

Anything else you would like us to know?

Emergency contact 1 (Name + phone number)

Emergency contact 2 (Name + phone number)