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The Sampson Standard Pet Care Request Form

Thank you for your interest in The Sampson Standard! Please complete this form so I can learn more about your pet, requested service, and care needs.

Submitting this form does not guarantee availability or confirm a booking. I’ll review your request and follow up with next steps, which may include a meet & greet, clarifying intake details, and vaccination status when applicable.

Client Information

Full Name:

Phone Number

Email Address

Address/Service Location ( Required for drop-ins, walks, pickup/drop-off, or in-home care)

How did you hear about The Sampson Standard?

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Service Details

Which service are you requesting?

Are you requesting any add-on services?

Requested Start Date:

Requested End Date:

Requested Time(s), if applicable (ex.:  morning drop-in, 12 PM walk, drop-off around 8 AM, pickup around 5 PM)

Is this a one-time request or a recurring care request?

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If Recurring, What Schedule Are You Hoping For? (type N/A if not recurring)

Pet Information

Name(s)

Species

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Breed/Mix:

Age(s):

Sex:

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Spayed/Neutered?

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Approximate Weight (if known)

Is Your Pet Current on Rabies Vaccination?

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For boarding/daycare only: are you able to provide proof of current rabies vaccination before the first stay?

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Care Routine

Feeding Instructions:

Potty/Litter Routine:

Medication and/or Supplements?

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B

If Yes to Medications or Supplements, Please Provide the Names, Dosage, and Schedule (type N/A if No is selected).

Any allergies, medical conditions, recent illness, injury, or surgery?

How Long Can Your Pet Comfortably Be Left Alone?

Behavior & Safety

How would you describe your pet's personality?

How does your pet do with small children? (Not applicable for clients only seeking Pet Waste Removal services)

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Is your pet friendly with other dogs? (Not Applicable for Cat Requests)

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How Does Your Pet Do With New People/Strangers?

Has your pet ever growled, snapped, bitten, lunged, or shown aggressive behavior toward a person or animal?

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If Yes or Unsure, Please Explain (Please note that checking yes does not automatically result in your request being declined - we simply like to know what the details surrounding the incident were to best help set your pet up for a successful stay!)

Does your pet have any history of resource guarding food, toys, beds, people, or space?

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Does your pet have any escape risks (check all that apply)?

Any anxiety, reactivity, destructive behavior, or other concerns?

Anything Else You'd Like to Share About Your Pet? (optional)

Pet Photo (optional) - You’re welcome to upload a photo of your pet so I can put a face to the name; however, this is optional and not required to submit the form.

Acknowledgement

By checking the box below, you indicate understanding of and agreement with the following: 
1) I understand this form does not confirm a booking.
2) I understand a meet & greet may be required before care begins.
3) I understand private clients may be required to sign a service agreement before services begin.
4) I understand boarding/daycare clients must provide current rabies vaccination proof before the first stay.
5) I understand The Sampson Standard only accepts pets whose needs can be safely met within a family-style care environment

I Have Read and Understand the Acknowledgements Above.