Owner Information
Name
Name
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Is this your first dog
Dog Information
What is your dogs activity level?
Walks, runs, in yard, at dog park, etc.
Please complete the following behavior information to allow us to best assist you and your dog:
Check all that apply and note the three most troublesome to you and your family in the box below the choices:
If you go near or touch your dog's food dish when he is eating, will he show his teeth, growl or snap?
If your dog has a toy, bone or piece of food in his mouth and you try to take it away, will he show his teeth, growl or snap?
If you grab your dog, does she ever show her teeth, growl or snap?
If your dog steals something (i.e. sock, food, tissue), will she show teeth, growl or snap?
If your dog is on your bed, couch or other favorite resting spot and you try to make him move, will he show teeth, growl or snap?
Does your dog, otherwise housetrained, ever urinate on your bed, furniture or other objects?
If your dog is lying on the floor and you roll him onto his back to clip her nails or check her for ticks, will she show teeth, growl or snap?
Have you ever been concerned with your dog's interaction with other dogs?
Have you ever been concerned with your dog's interaction with a relative, friend or stranger?
When you arrive home does your dog roll onto his back and urinate when he greets you?
If you discipline your dog, does he duck, crawl on his belly or roll on his back and urinate?
Yes No When you take your dog to an unfamiliar place is she fearful, does she hide, cower, shake or try to leave?