New Client Intake Form Completed once per dog. Please be as detailed as you like — there's no such thing as too much information. 1. Owner / Guardian Information Owner Name Preferred Name/Nickname Primary Phone Secondary Phone Email Address Home Address (Service Location) City ZIP Code How did you hear about A.D.A.P.T.? -- Select -- Google Search Nextdoor Facebook/Instagram Friend/Family Referral Vet Referral Other If Other, please describe 2. About Your Dog Dog's Name Nickname(s) Breed (or best guess) Age Weight (approx.) Sex -- Select -- Male Female Spayed / Neutered? -- Select -- Yes No Unknown Coat Type -- Select -- Short / smooth Medium Long Curly / wavy Double coat Wire / rough Unknown 3. Grooming History Has your dog been professionally groomed before? -- Select -- Yes — regularly Yes — occasionally No — this is their first time If yes, how does your dog generally respond to grooming? -- Select -- Loves it Tolerates it Anxious but manageable Very stressed Has had incidents What is their biggest challenge during grooming? Have they ever been refused service or asked not to return? -- Select -- No Yes — details below If yes, please explain 4. Temperament & Behavior How would you describe your dog's general personality? (Check all that apply) Relaxed / easygoing Playful / energetic Shy / reserved Anxious / nervous Reactive to dogs Reactive to people Protective / territorial Unpredictable Has your dog ever snapped, growled, or bitten during grooming or handling? -- Select -- Never Growled / warned Snapped (no contact) Snapped (made contact) Full bite Please describe the circumstances (triggers, context, frequency) Sensitive areas of the body (check all that apply) Paws / nails Ears Face / muzzle Tail area Back legs Belly Other sensitive areas or notes What helps your dog feel calm or comfortable? (Check all that apply) Treats / food rewards Familiar smells / toys Soft voice / gentle touch Being talked to Brief breaks Owner nearby Favorite music Quick pace Anything else that helps 5. Health & Medical Information Current or ongoing health conditions (check all that apply) No known conditions Arthritis / joint issues Skin condition Heart condition Diabetes Epilepsy / seizures Cancer (current/history) Vision / hearing impairment Other conditions or medications Known allergies? -- Select -- None known Yes — details below Allergy details Medications that affect behavior or stress tolerance? -- Select -- No Yes — details below Medication details Vaccinations current? -- Select -- Yes — fully current Partially current No / unknown Medical exemption 6. Veterinary Information Veterinary Clinic Name Veterinarian Name Vet Phone Number Vet Address (City) Date of Last Vet Visit Reason for Last Visit 7. Emergency Contact Emergency Contact Name Relationship Emergency Contact Primary Phone Emergency Contact Secondary Phone Authorized to make veterinary decisions on your behalf? -- Select -- Yes No 8. Service Preferences & Notes Services interested in (check all that apply) Full groom (bath + cut + dry + trim) Bath & brush-out only Nail trim Ear cleaning Deshedding treatment Puppy's first groom Senior-adapted groom Breed standard cut Specific style preferences or areas NOT to cut Anything else we should know about your dog? Owner Confirmation By submitting this form I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that A.D.A.P.T. uses this information to adapt grooming services to my dog's individual needs, and I agree to update this information if my dog's health or behavioral status changes significantly. Printed Name Date Submit Intake Form