First Name:
Last Name:
Preferred Name:
Email:
Sex:—Please choose an option—Choose an optionMaleFemalePrefer Not to Say
Ethnicity/Background:—Please choose an option—Choose an optionAfrican AmericanAsian AmericanHispanic/LatinoNative AmericanCaucasian/WhitePacific IslanderMultiracialOther (Please Specify)Prefer Not to Say
Zip Code:
Years of Experience:—Please choose an option—Choose an option0-12-56-1010+
Pet Preferences:—Please choose an option—Choose an optionCan't work with pet(s)Will only work with catsWill only work with dogs
Client Gender Preference:—Please choose an option—Choose an optionPrefer male clientPrefer female clientNo preference
Client Age Preference:—Please choose an option—Choose an optionDon't like to work with very old clientsComfortable with all ages
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