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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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