Daycare Questionnaire

Heart of Ankeny Animal Hospital

701 Ordnance Rd.
Ankeny, IA 50023

(515)635-0095

www.heartofankeny.com

Daycare Questionaire

Thank you for choosing Heart of Ankeny for your dog's care!
We strive to provide the best quality service including a healthy, calm, fun, and sanitary atmosphere! Therefore, we require our new daycare clients to fill out the following information to help us gain some knowledge about your dog(s). If you are registering more than one dog, please fill a form out for each individual dog.

Owner Name (required)

First Name (required)	Last Name (required)

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

Phone (required)
Phone Type	Phone Number (required)

E-Mail Address (required) :

Name of Dog: (required)

Gender: (required)

Male
Female

Age of Dog: (required)

Breed: (required)

How long have you owned your dog? (required)

Altered? (required)
(* All pets over 6 months of age are required to be spayed or neutered in order to participate in daycare.)

Yes
No

Medical History

Does your dog have any past or current medical issues or injuries we need to be aware of? (required)

Yes
No

If yes, please explain.

Is your dog current on age appropriate vaccinations? (required)
(* To attend daycare your dog must be current on Rabies, DAPP, and Bordetella vaccines.)

Yes
No

If you are not a veterinary patient of Heart of Ankeny please list your veterinarian. (required)

Is your dog current on flea/tick and heartworm prevention? (required)
(*to attend daycare it is required that your dog is current on flea/tick prevention.)

Yes
No

If yes, please list what products you are currently using.

Does your dog have any allergies or dietary restrictions? (required)

Yes
No

If yes, please explain.

Training History

Has your dog attended any training or obedience classes? (required)

Yes
No

If yes, please list classes/training attended below.

What commands does your dog know and respond to? (required)

Do you use and electronic fence or bark collar for your dog? (required)

Yes
No

If yes, please explain.

Social History

Describe your dog's energy level. (required)

Low
Medium
High

Has your dog ever bitten or been aggressive with a person? (i.e. groomer, vet, strangers) (required)

Yes
No

If yes, please explain.

Has your dog ever shown aggressive behavior towards another dog? (required)

Yes
No

If yes, please explain.

Has your dog ever been in a situation with another dog that resulted in a bite wound to either dog? (required)

Yes
No

If yes, please explain.

Does your dog have issues with loud noises or thunderstorms? (required)

Yes
No

Does your dog exhibit destructive behavior when left alone? (required)

Yes
No

Does your dog willingly accept handling by others? (i.e. grooming, nail trims, etc.) (required)

Yes
No

Is there anything your dog is scared of? Please list below and explain how you handle it (required)

Please list some of your dog's favorite activities. (required)

Has your dog ever jumped a fence or gate higher than 4 feet? (required)
(If yes, please list training completed.)

Yes
No

Does (or has) your dog shown signs of resource guarding? (toys, objects, people, etc.) (required)

Yes
No

If yes, please explain.

Has your dog been to an off leash park? (required)

Yes
No

Does your dog get along with other dogs or ever play in a group setting? (required)

Yes
No

Does your dog recall well? (required)

Yes
No

Does your dog ever bark excessively? (required)

Yes
No

Why do you want to bring your dog to play time? (required)

Verify the reCAPTCHA:

701 SW Ordnance Rd. Ankeny, IA 50023

(515) 635-0095

heartofankeny@gmail.com

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Shop our online store!

HOSPITAL HOURS

Day	Open	Closed
Monday	7:30 am	5:00 pm
Tuesday	7:30 am	7:00 pm
Wednesday	7:30 am	5:00 pm
Thursday	7:30 am	7:00 pm
Friday	7:30 am	5:00 pm
Saturday	7:30 am	12:00 pm
Sunday	Closed	Closed

CANINE CLUB HOURS

Day	Open	Closed
Monday	7:00 am	6:00 pm
Tuesday	7:00 am	6:00 pm
Wednesday	7:00 am	6:00 pm
Thursday	7:00 am	6:00 pm
Friday	7:00 am	6:00 pm
Saturday	7:00 am	12:00 pm
Sunday	Closed	Closed

Our employees are here
Saturdays at 6pm
& Sundays at
8am, 12pm, and 6pm
for boarding drop-off
& pick-up.

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Special Hours

We will be closed the following dates:

Thursday, November 28th, and Friday November 29th for the Thanksgiving Holiday.
Boarding drop-off and pick-up will not be permitted on Thursday, and must be scheduled at 8a, 12p, or 6p on Friday.
We will resume normal hours Saturday, November 30th from 8a-12p.

____________________________

About Your PetSite

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Get Directions

Pet Resources

Refer a friend to us and receive a $10 account credit!

701 SW Ordnance Rd. Ankeny, IA 50023

(515) 635-0095

heartofankeny@gmail.com

------------------------------

Shop our online store!

HOSPITAL HOURS

Day	Open	Closed
Monday	7:30 am	5:00 pm
Tuesday	7:30 am	7:00 pm
Wednesday	7:30 am	5:00 pm
Thursday	7:30 am	7:00 pm
Friday	7:30 am	5:00 pm
Saturday	7:30 am	12:00 pm
Sunday	Closed	Closed

CANINE CLUB HOURS

Day	Open	Closed
Monday	7:00 am	6:00 pm
Tuesday	7:00 am	6:00 pm
Wednesday	7:00 am	6:00 pm
Thursday	7:00 am	6:00 pm
Friday	7:00 am	6:00 pm
Saturday	7:00 am	12:00 pm
Sunday	Closed	Closed

Our employees are here
Saturdays at 6pm
& Sundays at
8am, 12pm, and 6pm
for boarding drop-off
& pick-up.

------------------------------

Special Hours

We will be closed the following dates:

____________________________

About Your PetSite

PetSites allows you to view your pet's medical history and vaccination reminders with ease!

Get Directions

Pet Resources

Refer a friend to us and receive a $10 account credit!

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