MM slash DD slash YYYY
Address(Required)
What days of the week are you available?(Required)
Do you crate your dog?
Do you have a separate room or place for your dog?
Do you tie your dog outside?
Do you have an outside kennel / run for your dog?
Where does your dog sleep at night
If on a couch or bed, will your dog vacate the spot at your request?
Is your dog spayed/neutered?
Are your dog’s vaccinations up to date?
Are there other dogs in the home?
Can your dog be safely left alone in your house?
Can your dog be safely left alone in your car?
Are there situations when your dog appears stressed?
Have you taken your dog to any training classes?
Does your dog easily comply with a request to give up anything in his/her possession?
If given a treat, does your dog take it gently?
Can your dog be petted, moved, or interrupted while eating?
Can all family members expect reasonable compliance to reasonable requests?
Is there a family member that your dog disregards or ignores?
When guests arrive is your dog out of control?
When at the vet’s office will your dog allow itself to be restrained and/or examined without struggling, growling, or biting?
When you encounter other dogs is your dog out of control?
Has your dog ever bitten a person?

Describe the bite:

Has your dog been in a dogfight with another dog?
Check all that apply:
Are there situations in which you feel you have little or no control over your dog?
Has your dog ever been on a choke, pinch, or shock collar?
Is your dog contained by any electronic fencing system?
Is food left out continually for your dog?
Any health problems?
Any medications?
My dog has problems with:
My dog has problems with the following inanimate objects:
My dog has problems with other dogs when they: