New Client Registration Form | Daly Dog Care

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

Daly Dog Care New Client Registration Form

To prove you're a real person (and not a SPAM bot), please check the I'm not a robot box below.

The Google SPAM test above works with Chrome, Safari, Firefox and Microsoft Edge browsers, not Internet Explorer. For best experience, use a computer. Phones may have issues uploading documents.

Remember to initial and sign the Animal Care Contract on the website, and upload your current vaccinations here in registration or bring them in for verification at your first visit.

Daly Dog Care Client Registration Form

Owner Information

First Name *Required* Required

Last Name *Required* Required

Phone Number *Required* Required

Email *Required* Required

Address

City

State | Province

Zip Code | Postal Code

Family Vet Clinic

How did you find us?

Emergency Contact (Include Phone Number)/Others Allowed to Pick Up Pet(s)

Pet #1 Information

Pet's Name *Required* Required

Breed *Required* (Best Guess) Required

Sex *Required* Required

Color Description

Date of Birth

Daly Dog Care requires proof of vaccination.

Rabies Expiration

DHLPP Expiration

Bordetella Expiration

—- Expiration

Microchip Code

Weight

Insurance Info

Feeding & Medication Notes

Aggressive behavior or temperament issues? (If extensive, tell us in person).

Anything else we should know? (If extensive, please tell us in person).

Please make sure your computer/phone internet browser is the most recent updated version, otherwise you might have issues uploading documents.

Pet Photo (Not Required. 5MB Max. Image Files Only)

Proof of Vaccinations (Not Required. 5MB Max. Only Images, No PDFs. Take a Picture of Document with Your Phone and Upload It.)

Click Here to Add a Second Pet

Pet #2 Information

Pet #2 Name *Req*

Breed *Required* (Best Guess)

Sex *Required*

Color Description

Date of Birth

Daly Dog Care requires proof of vaccination.

Rabies Expiration

DHLPP Expiration

Bordetella Expiration

—- Expiration

Microchip Code

Weight

Insurance Info

Feeding & Medication Notes

Aggression/temperament issues? (If extensive, please tell us in person.).

Anything else you'd like us to know?

Pet Photo (Not Required. 5MB Max. Image Files Only.)

Proof of Vaccinations (Not Required. 5MB Max. Only Images, No PDFs. Take a Picture of Document with Your Phone and Upload It.)

Click Here to Add a Third Pet

ALERT: If you have more than three pets, submit the form once with your first three pets and then fill it out again with the information for your extra pets.

Pet #3 Information

Pet #3 Name *Req*

Breed *Required* (Best Guess)

Sex *Required*

Color Description

Date of Birth

Daly Dog Care requires proof of vaccination.

Rabies Expiration

DHLPP Expiration

Bordetella Expiration

—- Expiration

Microchip Code

Weight

Insurance Info

Feeding & Medication Notes

Aggression/temperament issues? (If extensive, please tell us in person.).

Anything else you'd like us to know?

Pet Photo (Not Required. 5MB Max. Image Files Only.)

Proof of Vaccinations (Not Required. 5MB Max. Only Images, No PDFs. Take a Picture of Document with Your Phone and Upload It.)

IMPORTANT: Do you want to request an appointment as well? Click here.

Sorry, but spammers are really smart these days. One last time, to prove you're not a robot, what does 2+2 equal?

Here's a hint: 4

If the form doesn't submit, please scroll up and make sure all required pet and owner fields are filled in. If the issue persists, send an email to dalydogcareinc@gmail.com