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New Client Application
Step 1 of 6 - Health Protocols
16%
Health & Behavior Protocols
Please confirm:
*
I have read and understand Tappen Hill's health & behavior protocols
I will bring or fax my dog’s current vaccination records and negative fecal test results.
You can review our
Health & Behavior Protocols
in the
"About" section
of our website.
Client Information
Name
*
First
Last
Spouse's Name
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone (Home)
*
Phone (Cell)
Phone (Cell #2)
Email
*
Referred By
Pet Information
How many dogs?
*
One
Two
Three
Dog #1
Name of Dog
Breed
Sex
Male
Female
Has your dog been spayed?
Yes
No
When was your dog neutered?
0-6 months
6-12 months
1-3 years
3 years and over
Unknown
Has not been neutered
Neutering plans
Our plans include neutering our puppy before 6 months
Our plans include neutering our puppy after 6 months
We do not plan on neutering our puppy
For puppies under 6 months only
Age
Date of Birth
Date Format: MM slash DD slash YYYY
Weight
Notes
Dog #2
Name of Dog
Breed
Sex
Male
Female
Has your dog been spayed?
Yes
No
When was your dog neutered?
0-6 months
6-12 months
1-3 years
3 years and over
Unknown
Has not been neutered
Neutering plans
Our plans include neutering our puppy before 6 months
Our plans include neutering our puppy after 6 months
We do not plan on neutering our puppy
For puppies under 6 months only
Age
Date of Birth
Date Format: MM slash DD slash YYYY
Weight
Notes
Dog #3
Name of Dog
Breed
Sex
Male
Female
Has your dog been spayed?
Yes
No
When was your dog neutered?
0-6 months
6-12 months
1-3 years
3 years and over
Unknown
Has not been neutered
Neutering plans
Our plans include neutering our puppy before 6 months
Our plans include neutering our puppy after 6 months
We do not plan on neutering our puppy
For puppies under 6 months only
Age
Date of Birth
Date Format: MM slash DD slash YYYY
Weight
Notes
Emergency Contact #1
Name
First
Last
Relationship
Phone (Home)
Phone (Work)
Phone (Cell)
Phone (Pager)
Phone (Fax)
Email
Emergency Contact #2
Name
First
Last
Relationship
Phone (Home)
Phone (Work)
Phone (Cell)
Phone (Pager)
Phone (Fax)
Email
Primary Veterinarian Contact Information
Name
First
Last
Specialty
Clinic
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone (office)
Phone (after hours)
Phone (fax)
Email
Specialist Vet
Do you have a specialist vet?
*
Yes
No
Specialist Contact Information
Name
First
Last
Specialty
Clinic
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone (office)
Phone (after hours)
Phone (fax)
Email
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