| Your Dog’s Name: |
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| Date of birth: |
0000-00-00
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| Breed: |
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| Sex:
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| Neutered/spayed?
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| Has this dog had other owners?
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| How long have you had this dog? |
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| What is your dog’s relationship to the other people and animals in the household (friendly, hostile, fearful)? |
Friendly |
| When did your dog last have an annual wellness check with your veterinarian? |
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| Is your dog current on the following vaccinations? |
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| When did your dog last have a fecal test? |
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| Does your dog have any medical conditions? |
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| If yes, please note details of any medication: |
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| Where does your dog sleep at night? |
Other:
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| How many hours a night does your dog sleep? |
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| Is the dog’s sleep uninterrupted? |
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| How is your dog contained when you are out of the home? |
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| How well does your dog relax in your home when there is no activity? |
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| When your pet is left “Home Alone” do you? |
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| Did your dog attend a puppy socialization class?
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| Have you ever attended pet dog manners (obedience) training classes with your dog?
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| Does your dog reliably do the following when asked?
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| Has your dog ever participated in any of these activities?
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| Has your dog ever participated in any of these activities?
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Other:
| How do you exercise your dog each day?
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Other:
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| On average per day how long do you exercise your dog ?
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| What do you feed your dog?
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| How do you feed your dog?
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| What treats does your dog enjoy?
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| What toys does your dog enjoy?
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| What does your dog do when you have guests?
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| How does your dog behave around other dogs?
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| Please indicate if your dog gets stiff, growls or shows teeth when:
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| How is your dog when left alone?
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| How is your dog during thunderstorms/fireworks?
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| Does your dog guard resources?
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