Timberline Canine Questionnaire

*Any Treats Must be Provided in a Hard-Sided, Sealable Container, and Supplements and Medications in Their Original Containers.

Your Name *Please enter your first and last name
Address *
Phone 1 *
Phone 2
Email
Information about your dog(s) *For each of your dogs please list the name, breed, sex, weight and vaccination status (current, unvaccinated or titered).
Please provide details about the color and any markings on your dog. *
Regular Veterinarian, Clinic Name and Phone Number *Please list your regular Veterinarian including the Clinic Name and Phone Number
Supplements and Medications - Times and Amounts *Please list any Supplements and/or Medications including Times and Amounts to be administered.
Any Habits/Behaviors of Which We Should be Aware *
Any Physical Conditions/Injuries of Which We Should be Aware? *

*Any Treats Must be Provided in a Hard-Sided, Sealable Container, and Supplements and Medications in Their Original Containers.