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Canine Behavior History Form
PET INFORMATION
Name: _______________ Breed:_______________ Sex: M ( F ( Spayed ( Neutered ( Age:______
MEMBERS IN HOUSEHOLD
Please list all family members currently living in the household
|Name |Relationship |Sex |Age |Relationship with Pet |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
• Are there children that interact with your dog (other than those listed above)? ( Yes ( No
o If yes, please describe.______________________________________________________________________________________
________________________________________________________________________________________________________
• Who is the primary caretaker of the dog in your household?_________________________________________________________
PETS IN HOUSEHOLD
Please list all other pets currently living in the household.
|Name |Species |Breed |Sex |Age |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
• Do all the pets in your household get along with each other and interact well? ( Yes ( No
• If yes, please describe.________________________________________________________________________________________
__________________________________________________________________________________________________________
• Are any pets kept apart due to aggression? ( Yes ( No
o If yes, which pets?_________________________________________________________________________________________
o For how long are pets kept apart?_____________________________________________________________________________
o Please describe.___________________________________________________________________________________________
PET HISTORY
• Where did you get your dog?__________________________________________________________________________________
• At what age?__________
• At what age was your pet spayed/neutered?__________
• Did you meet the parents of your dog? ( Yes ( No
o If you met the mother, how would you describe her temperament (check all that apply)?
( Quiet ( Calm ( Excitable ( Unruly ( Bold ( Confident ( Shy ( Fearful ( Aggressive ( Other________
o If you met the father, how would you describe his temperament (check all that apply)?
( Quiet ( Calm ( Excitable ( Unruly ( Bold ( Confident ( Shy ( Fearful ( Aggressive ( Other________
o Do your dog’s parents/littermates show similar behaviors as your dog?
( Yes ( No (Unknown (Other______________
• For what purpose did you obtain your dog? (check all that apply)
( Companion ( Protection ( Competition/Show ( Service/Working/Hunting ( Breeding ( Other_______________
• If your obtained your dog as a puppy, please answer the following:
o How was it raised prior to your home? (check all that apply)
( Indoors ( Outdoors ( Kennel ( Garage ( Puppy Mill ( Unknown ( N/A ( Other____________________
o How did you select your puppy? (check all that apply)
( Breeder selected ( No choice ( Outgoing ( Timid ( Size ( Dominant ( Submissive ( Markings
( Conformation ( Sex ( N/A ( Other____________________________
o Did your puppy ( 10x/day ( 1-10x/day ( 1-6x/wk ( 10x/day ( 1-10x/day ( 1-6x/wk ( 10x/day ( 1-10x/day ( 1-6x/wk ( 10x/day ( 1-10x/day ( 1-6x/wk ( 10x/day ( 1-10x/day ( 1-6x/wk ( 10x/day ( 1-10x/day ( 1-6x/wk ( 10x/day ( 1-10x/day ( 1-6x/wk ( 10x/day ( 1-10x/day ( 1-6x/wk ( ................
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