Dog History Form

"*" indicates required fields

Owner's Name*
Address*
Sex
Spayed/Neutered?*
Where did you get this dog?
Why are you needing to re-home this dog?
What other pets did your dog live with?

Behavior History

How does your dog behave toward other dogs on a leash? Please check all that apply.
How does your dog behave/interact with adults?
How does your dog behave/interact toward other familiar dogs in your household?
How does your dog behave/interact toward cats in your household?
How does your dog behave/interact with young children?
How does your dog behave/interact with older children/teenagers?
How does your dog behave/interact at the vet's office?
Does your dog have any of the following behaviors? Please select all that apply.
If you did discipline your dog, what was it disciplined for?
What methods were used to discipline your dog?
Is your cat afraid of any of the following?
What is your cat's behavior when it is afraid? Please select all that apply.

Exercise and Play

What type of toys does your cat like to play with? Please select all that apply.
What is your cat's play style?
What is your cat's activity level?

Food/Diet

Is your dog currently on any medication or special diet?
What type of food does your dog eat?
How often do you feed your dog?

Medical History

Name of owner/person on the account at the veterinary clinic.
Does your dog have a microchip?
Does your dog have any past or present medical conditions?
Max. file size: 128 MB.
This field is for validation purposes and should be left unchanged.