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Canine Health and Fitness Assessment

Part 1: General

(to be completed by Owner)

Owner's First Name

Owner's Last Name

Dog's Name

Dominant breed

Gender

Male

Female

Spayed/neutered

Yes

No

Color

Birthday

Overall health (1 = poor, 10 = excellent)

Overall activity level (1 = laid back, 10 = hyper)

Current diet – describe your dog’s diet for both AM and PM (product name, quantity, when fed – include treats and table scraps)

Current exercise – describe your dog’s daily exercise (walks, brisk walks, runs, hikes, dog parks, swims)

What physical activities does your dog enjoy?

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Customer Service

info@club-k9.com

1508 Moran Road

Sterling, VA 20166

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