The form below is for new clients only. If you're already a client of Leafields Dog Retreat, please click here to request an appointment.

Leafields Dog Retreat New Client Registration Form

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Please fill out the form below only if instructed to having spoken with Leafields. We will email you a waiver to e-Sign once we receive your registration information. Thank you

Important: In addition to the online form below, please print the following PDF document and bring it to your first appointment: Click to Print

Owner Information

First Name *Required*

Last Name *Required*

Phone Number *Required*

Email *Required*

Address *Required*

City *Required*

State | Province *Required*

Zip Code | Postal Code *Required*

Family Vet Clinic *Required*

How did you find us? *Required*

Emergency Contact (Include Phone Number)/Others Allowed to Pick Up *Required*

Owner Question #1: Please do not complete the registration form unless at the request of Leafields. Please phone first *Required*

Owner Question #2: How has your dog been socialised to date? *Required*

Owner Question #3: What services are you interested in? *Required*

Pet #1 Information

Pet Name *Required*

Breed (Best Guess) *Required*

Sex *Required*

Color Description *Required*

Date of Birth *Required*

Important: All dogs MUST be update with following vaccines at registration: CANINE DISTEMPER, INFECTIOUS HEPATITIS, LEPTOSPIROSIS, KENNEL COUGH.

Kennel Cough Expiration *Req*

Boosters Expiration *Req*

Microchip Code *Required*

Weight *Required*

Insurance Info *Required*

Feeding Notes *Required*

Medication Notes *Required*

Temperament Notes (Aggression, anxiety, etc? If extensive, tell us in person). *Req*

Additional Notes (Anything else we should know? If extensive, tell us in person.) *Req*

Pet Question #1: Does your dog have basic recall skills? *Required*

Pet Question #2: Is your dog social with all breeds, sizes, ages? *Required*

Pet Question #3: Please confirm your dog has no signs of aggression either to other dogs or humans. *Required*

Pet Question #4: How does your dog rest at home? Please state if crated trained or not. *Required*

Pet Question #5: Any food habits/ medication needs or health issues - please inform us here *Required*

Mobile Phone Alert: Some phones have difficulty uploading the files below (the form gets reset after uploading). If this happens on your phone, please submit this form using a computer. You can also submit this form on your phone without uploading anything and then email your pet picture and vaccine verification document to us at hello@leafields.co.uk. Thanks!

Pet Photo (Not Required. 5MB Max. Image Files Only)
Click to Upload Pet Picture

Proof of Vaccinations (5MB Max. Only Images, No PDFs. Take a Picture of Document with Your Phone and Upload It.)

Click to Upload a Picture of Proof of Vaccinations

Click Here to Add a Second Pet

Pet #2 Information