Canine Behavior and History Questionnaire Form (On Leash)

Owner Name:*

Owner Email:*

Owner Phone Number:*

What neighborhood in Asheville or surrounding area do you live in?*

How did you hear about us?*

Dog's Name:*

Dog's Age:*

Dog's Birthday*

Breed:*

Color/Markings:*

Dog's Sex*

What vaccines is your dog current on:*

Additional Vaccines? (Lepto, Lymes, Bordetella/Kennel Cough, Rattlesnake etc.)*

When was your dog last vaccinated:*

How long have you lived with your dog?*

Where did you get your dog?*

What do you know about your dog's history?*

Has your dog ever escaped from your yard?*

Is your dog potty trained to a yard? Does she or he need prompting or an escort in order to go?*

Does your dog use a crate?*

How much does your dog weigh?*

Under what circumstance is your dog most likely to bark at other people or dogs?*

How does your dog do in the car?*

Does your dog bark excessively at people or dogs from inside your car?*

Have you or do you currently train your dog using a collar that issues an electric shock? If so, please describe how you are using the collar and what behaviors you are trying to train.*

Has your dog ever growled at you? If yes, please explain:*

Has your dog ever bitten you, someone else or another dog? If yes, please explain:*

Can you take food, toys or stolen goodies away from your dog?*

Is there any situation or body area where you cannot touch your dog?*

Are there any people that your dog is uncomfortable around?*

Describe your dog's interaction with other dogs:*

How does your dog interact with small dogs - do you notice any over arousal or prey drive related behaviors?*

What kind of exercise does your dog get? How much and how often?*

Do you currently have a dog walker?*

Does your dog go off leash in parks and trails?*

How reliable is your dog's recall?*

Has your dog ever gone to doggie daycare? How did your dog like it?*

When walking on or off leash does your dog exhibit vocalizing, lunging or hyper distraction in response to environmental triggers? (presence of other dogs, skate boards, mail truck etc.)*

Is your dog comfortable walking on leash with other dogs?*

Is your dog allergic to anything?*

Is your dog on any medication? If so, please list:*

Does your dog have any injuries or physical concerns I should be aware of?*

Does your dog like to roll in anything? Or eat feces? *

What (if any) cues/commands does your dog know and respond to?*

Is there anything else you would like me to know?*