Canine Behavior Form

Dog's Name:

Dog's Breed:

Dog's Date of Birth:

Is this birth date:

Estimated

Known

Age at Adoption ( _ weeks, _ month):

Dog's Sex:

Is your dog house-trained?

Yes

No

Do you have any worries, complaints, or problems with urination in the house now?

Yes

No

Do you have any worries, complaints, or problems with defecation in the house now?

Yes

No

Does your dog experience periodic bouts of diarrhea?

Yes

No

Does your dog destroy anything (for example, doors, windows, sofas, shoes, or other objects)?

Yes

No

Does your dog mouth anything or anyone?

Yes

No

Does your dog make any sounds that worry you?

Yes

No

Does your dog growl, bark, snarl, or bite?

Yes

No

Does your dog pull on the lead or do other things that make it hard for you to walk with a leash?

Yes

No

Have you ever worried that your dog is aggressive to people?

Yes

No

Have you ever worried that your dog is aggressive to other dogs?

Yes

No

Have you ever worried that your dog is aggressive to animals other than dogs?

Yes

No

Has your dog ever bitten anyone, regardless of the circumstances?

Yes

No

Have your dog's sleeping habits changed?

Yes

No

Have your dog's eating habits changed?

Yes

No

Has your dog's ability to move around or jump on the bed changed?

Yes

No

Has anyone ever told you that they were afraid of your dog?

Yes

No

Is your dog behaving in any way that worries you or about which you would like more information?

Yes

No

Canine Behavior Form

Dog's Name:

Dog's Breed:

Dog's Date of Birth:

Is this birth date:

Age at Adoption ( ___ weeks, ___ month):

Dog's Sex:

Is your dog house-trained?

Do you have any worries, complaints, or problems with urination in the house now?

Do you have any worries, complaints, or problems with defecation in the house now?

Does your dog experience periodic bouts of diarrhea?

Does your dog destroy anything (for example, doors, windows, sofas, shoes, or other objects)?

Does your dog mouth anything or anyone?

Does your dog make any sounds that worry you?

Does your dog growl, bark, snarl, or bite?

Does your dog pull on the lead or do other things that make it hard for you to walk with a leash?

Have you ever worried that your dog is aggressive to people?

Have you ever worried that your dog is aggressive to other dogs?

Have you ever worried that your dog is aggressive to animals other than dogs?

Has your dog ever bitten anyone, regardless of the circumstances?

Have your dog's sleeping habits changed?

Have your dog's eating habits changed?

Has your dog's ability to move around or jump on the bed changed?

Has anyone ever told you that they were afraid of your dog?

Is your dog behaving in any way that worries you or about which you would like more information?

Age at Adoption ( _ weeks, _ month):