Dog Admissions Form

  Please complete the following contact information

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Name:

 

 

   

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City/State/ZIP:

 

    

 

 

 

 

What's this?

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Question - Required - How does your dog typically behave toward the following? (check all that apply) Men your dog knows:

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Question - Required - Women your dog knows:

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Question - Required - Children your dog knows:

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Question - Required - Unfamiliar men:

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Question - Required - Unfamiliar women:

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Question - Required - Unfamiliar children:

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Question - Required - Dogs your dog knows:

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Question - Required - Cats your dog knows:

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Question - Required - Unfamiliar dogs:

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Question - Required - Unfamiliar cats:

 
Question - Not Required - Does your dog typically uncontrollably chase or attempt to chase any of the following? (check all that apply)

   


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Question - Required - How does your dog usually react when you or another family member does the following? (check all that apply) Bathe:

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Question - Required - Brush

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Question - Required - Wipe feet

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Question - Required - How does your dog usually react when an unfamiliar person approaches or enters the yard or house?

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Question - Required - When left alone, does your dog usually show any of the following behaviors?

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Question - Required - When you are home, does your dog usually show any of the following behaviors?

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Question - Required - When your dog plays, does he/she typically ...

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Question - Required - What toys does your dog like?

   


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Question - Required - What games does your dog like?

   


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Question - Required - What commands does your dog know?

   


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Question - Required - Check the appropriate box(es) if your dog has ever shown any of the following aggressive behaviors toward: Men

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Question - Required - Women

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Question - Required - Children

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Question - Required - Dogs

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Question - Required - Other domesticated animal species (cat, livestock, etc.)

 


 


   


   


 
Question - Not Required - Was the aggressive behavior over food?

 
Question - Not Required - Was it over bones, rawhides or chews?

 
Question - Not Required - Was it over toys?

 
Question - Not Required - Was it over stolen objects?

 
Question - Not Required - Was it when the dog was disturbed while sleeping or resting?

 
Question - Not Required - Was it when someone was handling the dog (brushing, handling feet, bathing, teeth brushing, ear cleaning, etc. excluding a reaction to a vet or groomer)?

 
Question - Not Required - Was it when someone entered the house or yard?

 
Question - Not Required - Was it when an adult or child approached or reached toward the dog?

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Question - Not Required - Check the appropriate box(es) if your dog has ever shown any of the following aggressive behaviors when handled by a veterinarian or groomer: Examine (including heart and ears)

 
Question - Not Required - Restrain

 
Question - Not Required - Administer shots

 
Question - Not Required - Trim nails

 
Question - Not Required - Take blood

 


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Question - Required - What type(s) of food does your dog eat?

   


   Please leave this field empty