Registration Form

Apache Farms
163 Deer Park Road
Kerrville, TX. 78028

830-792-9171

Dog Intake Form

General information -

Today's Date *

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Alternate Phone Number *

Email *

Pet information -

Name of dog *

Breed *

Age *

Weight *

Color(s), Distinguishing marks *

Sex of dog *

Is your dog spayed/neutered? *

Yes No

Does your dog have a microchip? *

Yes No Unsure

Has your dog bitten in the last 10 days? *

Yes No Unsure

If yes, please explain *

Medical history -

Veterinarian Name *

Phone number *

Is your pet up to date on vaccinations? *

Yes No

Do these vaccinations include: Canine parvovirus, distemper, rabies, and bordetella? *

Yes No

Has your pet ever had surgery? *

Yes No

If yes, please explain *

Is your dog receiving any flea control? *

Yes No

If yes, which brand? *

Does your pet have any other illnesses or conditions we need to know about? *

Yes No

If yes, please explain *

Dietary habits -

Which does your dog eat? *

Dry only Canned only Combination of dry and canned People food

What is your pet's favorite brand of food? *

What type of treats does your pet enjoy? *

How often is your pet fed? *

Food always available Designated mealtimes

Personality

Other: *

Submit

Apache Farms163 Deer Park RoadKerrville, TX. 78028 830-792-9171Dog Intake Form

General information -

Pet information -

Medical history -

Dietary habits -

Personality

Apache Farms
163 Deer Park Road
Kerrville, TX. 78028

830-792-9171

Dog Intake Form