dog, cat, boarding, kennel, day care, pet therapy

     38322 Delafield Rd
            Oconomowoc, WI 53066

      Phone: (262) 244-7549
            Fax: (262) 244-0786

Aqua Paws Questionnaire

If you are interested in bringing your pet to use Canine Campus Pet Resort's Aqua Paws treadmill, please fill out the questionnaire below once for each pet.

Then what do I do?

Bring proof of rabies
Make sure dog has eaten at least 2 hrs. before exercising
Dog must be CLEAN and brushed
Bring your own towel(s)
Make sure your dog has eliminated before starting

No dogs with open wounds will be able to participate.

Canine Campus Aqua Paws Application

Contact Info
Owner's Name
Address
Phone
Cell Phone
Work Phone
E-Mail Address
Pet
Pet's Name
Date Of Birth or Age
Spayed/Neutered
Gender
Breed
How does your pet react to other people? (Select all that apply using Ctrl+Click to make multiple selections)
Has your pet ever bitten another animal or person?
Does your pet require muzzling at the veterinarian?
Any other information you would like to give us that would make your pet's stay more comfortable or safer?
Medical History
1. Would you say your dog is grossly overweight?
2. Has your veterinarian ever said your dog has heart or lung problems?
3. Has your dog ever experienced seizures, uncoordinated gait or been diagnosed with a neurologic disorder?
4. Has your dog ever been diagnosed with high blood pressure
5. Has your dog had surgery for more than a routine spay/neuter?
6. Does your dog experience severe wheezing, coughing, shortness of breath or any difficulty breathing brought on by exercise?
7. Has your vet ever told you your dog has diabetes?
8. Is there a reason not mentioned here why your dog should not engage in exercise?
9. Is your dog pregnant?

10. Is your dog over the age of seven (7)? **
11. Does your dog have any bone, back or joint problems that will be aggravated by exercise? Example: arthritis or injury in knee, hock, spine or shoulder.**
12. What is your dog’s present exercise routine?
13. List all medications:
If any question 1-9 (above the line) is answered “yes” veterinary clearance is required for participation. Please download this form and take it to your vet to sign. Fax the completed signed form to (262) 244-0786 By submitting this form you agree to the following statement. **I will assume all risk associated with "yes" response(s) to question 10 & 11 and contend that my dog is able to participate in a water exercise program. (Fido Fitness Aqua Paws)

Last Updated 06/26/2008 by The Scholtz Site, Images and Information to bring your business to the World Wide Web