Yes

Yes

No

Don’t know

Is the Pedigree available?

No

Yes

Dog Name:

Age:

Weight:

Is the dog Spayed/Newtered?

Where did you get this dog?

How long have you had this dog?

Is dog a purebred?

Are vaccinations current?

Veterinarian's Name:

Veterinarian's address:

Do you have AKC papers?

Is the dog on heartworm preventiative?

Has this dog ever had a seizure?

If yes, how often does the dog have seizures?

If yes, what medication is the dog on for seizures?

List any orthopedic problems such as hip dysplasia, arthritis, stiffness or difficulty moving around:

Skin condition - any allergies?

Please list any other medical conditions:

What is your dogs disposition?

Is your dog confident or shy?

Choose what you can do with your dog? ( Select if yes, ctrl+select for multiple choices)

Does your dog? (Select if yes.  ctrl+select for multiple choices)

If yes to thunder, what does the dog do during a thunderstorm?

The dog gets along with: (ctrl+select for multiple choices)

Is this dog aggressive towards other dogs?

If Yes, what did the dog do to make you think it didn't like the other dog?

Is the dog possessive over food dish?

Has your dog ever lived with children?

If yes, for how long and what were their ages?

How did the children treat the dog?

Choose if the dog accepts (ctrl+select for multiple choices)

Is there anywhere the dog does NOT like to be touched?

Has your dog ever growled at or bit a person?

Has your dog ever growled or bit another animal like dog or cat?

Has your dog displayed any other signs of aggression? Please describe or enter N/A.

If yes, please explain:

Does your dog like to chasse bikes or cars?

What does your dog dislike?

Has this dog been to obedience school?

Does the dog know any commands?  Please list:

What are your training methods?  Please describe:

How do you excercise your dog?

What kind of food and supplements is your dog on?

What are your dog's good points?

Is your dog kept inside or outside?

Is your dog housebroken?

Is your dog crate trained?

No

Yes

Don’t know

No

Yes

If yes, what brand is used?

Don’t know

No

Yes

No

Yes

Don’t know

No

Yes

Don’t know

No

Yes

No

Yes

Don’t know

No

Yes

Don’t know

No

Yes

Behavior Assessment

Home Environment Assessment

No

Yes

Don’t know

No

Yes

Don’t know

No

Yes

No

Yes

No

Yes

No

Yes

No

No

Yes

No

Yes

No

Yes

Phone:

Owners Name:

Owners email: