We Love Your PetsNew Client Intake FormPlease complete the new client intake form below so we can learn about you and your pets, gather important care and home access details, and review required policies and service agreements prior to scheduling your first visit. "*" indicates required fields Owner / Account InformationFirst Name*Last Name*Email Address* Mobile Phone*Secondary PhoneHome Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact Name*Emergency Contact Phone*Emergency Contact RelationshipSelectFriendFamilyNeighborOtherHow did you hear about us?SelectGoogleYelpReferralVetEventOtherService InterestWhich services are you interested in? Dog Walking Drop-In Visits Pet Taxi Household Pet CountHow many pets need care?*1234+Pet 1 ProfilePet Name*Species*DogCatOtherBreed / MixAgeWeightGender Male Female Spayed / Neutered Yes No Microchipped? Yes No Collar / Harness TypeSelectFlatMartingaleHarnessHead CollarPhoto UploadAccepted file types: jpg, jpeg, png, heic, webp, Max. file size: 10 MB. Personality & BehaviorFriendly with Dogs? Yes No Selective Friendly with People? Yes No Slow to Warm Energy LevelSelectLowModerateHighVery HighLeash BehaviorSelectExcellentPullsReactiveFearfulHandling Restrictions No dog parks No off-leash Avoid children Avoid other dogs Bite History? Yes No Escape Risk Low Moderate High Known TriggersHealth & MedicalMobility Issues Arthritis Hip Dysplasia Blind Deaf AllergiesMedical ConditionsMedications Required? Yes No Do we need to give your pet any medications?Medication InstructionsFeeding InstructionsTreat RestrictionsWalking & Care RoutineUsual Walk LengthSelect Walk Length304560Preferred Walk TimeSelectMorningMiddayAfternoonEveningCan be walked with other dogs? Yes No Off-leash allowed? Yes No Pet 2 ProfilePet Name*Species*SelectDogCatOtherBreed / MixAgeWeightGender Male Female Spayed / Neutered Yes No Microchipped? Yes No Collar / Harness TypeSelectFlatMartingaleHarnessHead CollarPhoto UploadAccepted file types: jpg, jpeg, png, heic, webp, Max. file size: 10 MB. Personality & BehaviorFriendly with Dogs? Yes No Selective Friendly with People? Yes No Slow to Warm Energy LevelSelectLowModerateHighVery HighLeash BehaviorSelectExcellentPullsReactiveFearfulHandling Restrictions No dog parks No off-leash Avoid children Avoid other dogs Bite History? Yes No Escape Risk Low Moderate High Known TriggersHealth & MedicalMobility Issues Arthritis Hip Dysplasia Blind Deaf AllergiesMedical ConditionsMedications Required? Yes No Medication InstructionsFeeding InstructionsTreat RestrictionsWalking & Care RoutineUsual Walk LengthSelect Walk Length304560Preferred Walk TimeSelectMorningMiddayAfternoonEveningCan be walked with other dogs? Yes No Off-leash allowed? Yes No Pet 3 ProfilePet Name*Species*SelectDogCatOtherBreed / MixAgeWeightGender Male Female Spayed / Neutered Yes No Microchipped? Yes No Collar / Harness TypeSelectFlatMartingaleHarnessHead CollarPhoto UploadAccepted file types: jpg, jpeg, png, heic, webp, Max. file size: 10 MB. Personality & BehaviorFriendly with Dogs? Yes No Selective Friendly with People? Yes No Slow to Warm Energy LevelSelectLowModerateHighVery HighLeash BehaviorSelectExcellentPullsReactiveFearfulHandling Restrictions No dog parks No off-leash Avoid children Avoid other dogs Bite History? Yes No Escape Risk Low Moderate High Known TriggersHealth & MedicalMobility Issues Arthritis Hip Dysplasia Blind Deaf AllergiesMedical ConditionsMedications Required? Yes No Medication InstructionsFeeding InstructionsTreat RestrictionsWalking & Care RoutineUsual Walk LengthSelect Walk Length304560Preferred Walk TimeSelectMorningMiddayAfternoonEveningCan be walked with other dogs? Yes No Off-leash allowed? Yes No More than 3 pets? Please submit this form, and we’ll be in touch to collect details for any additional pets beyond Pet 3.Home Access & SecurityEntry MethodSelect Entry MethodKeyLockboxSmart LockConciergeAlarm System? Yes No Alarm InstructionsParking InstructionsDoor / Gate Escape RisksWhere should pet be left after visit?Veterinary InformationVeterinary Clinic NameVet Phone NumberVet Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred Emergency ClinicEmergency Contact Authorization I authorize you to seek emergency veterinary care if I cannot be reached. Pet Care Supplies LocationFood LocationLeash LocationTreat LocationCleaning Supplies LocationWaste Disposal InstructionsScheduling PreferencesVisit FrequencySelect Visit FrequencyOne-timeWeeklyDailyAs neededArrival Window PreferenceSelect ArrivalEarly AMMiddayAfternoonEveningSame walker preferred? Yes No OK with substitute walker? Yes No Photo & Update PreferencesWould you like visit photos? Yes No Visit Report Card? Yes No Preferred Update MethodSelectAppTextEmailPet Taxi Transport AuthorizationDo you authorize pet transport when services require it? Yes No Pets may be crated or seat-restrained during transport I Understand & Approve Transport may include multiple pets I Understand & Approve Final NotesAnything else we should know?Policies & AgreementsBy checking the boxes below and submitting this form, I acknowledge that I have read, understood, and agree to be legally bound by the referenced policies and agreements.Service Agreement Acceptance* I agree to the Service Agreement. Click on link to download and read the service agreement. Sonoma Dog Walker Service AgreementVeterinary Release I agree to the Veterinary Release. Click on link to download and read the service agreement. Sonoma Dog Walker Veterinary Release AgreementLiability Waiver I agree to the Liability Waiver. Click on link to download and read the service agreement. Sonoma Dog Walker Liability Waiver AgreementCancellation Policy Acknowledgment I acknowledge the Cancellation Policy. Click on link to download and read the service agreement. Sonoma Dog Walker Cancellation PolicyEntry Authorization I authorize Sonoma Dog Walker to enter my home for scheduled services Marketing Photo/Video Consent Yes — you may use photos/videos of my pet for marketing (no personal identifying info). No — please do not use my pet’s photos/videos for marketing. Client Signature*Signature Date* MM slash DD slash YYYY [scout_form] Phone 415-419-9063 Emailcontact@dogwalkersonoma.com