Canine Questionnaire Owner Information: Your Name(s): Phone: 1 2 Email: 1 2 How many pets do you have? Dog(s) 1 2 3 Other Cat(s) 1 2 3 Other Bird(s) 1 2 3 Other Other How many dogs have you owned/lived with? This is my first dog ever This is my first dog as an adult I've had several dogs If you have a pure bred dog, why did you choose that breed? Who is your breeder and what is their website address? What phrase best describes the choice of this particular dog? Only one to choose from Breeder chose dog for me Dog chose me Felt sorry for dog Always wanted this breed Dog Information Dog's Name Breed/Mix Spayed/Neutered: Yes No Age of dog when obtained? 2 to 6 months 6 months to 2 years 2–6 years over 6 years Age of dog now? 2 to 6 months 6 months to 2 years 2–6 years 6–9 years over 9 years Where did you get this dog? Breeder Nearby shelter Nearby rescue group On line rescue/shelter Pet store Friend Stray How many hours/day does your dog spend alone while you work? Zero, never alone Why? Less than five hours Less than eight hours More than eight hours When you are at work, your dog Goes out with you at midday Has a dog walker at midday Goes out in a 'play group' Goes to doggie daycare Has a dog door to a fenced yard Waits until you get home When you're not at home, your dog is In a crate In one room only Free in house In the yard Where does your dog sleep? With you in bed On a dog bed in bedroom Where he/she pleases In crate in bedroom In crate in kitchen Who is your veterinarian? Name of practice? Town? Date of and reason for your pet's most recent visit to a veterinarian Rabies Vaccine date Distemper complex Heartworm Prevention? Yes No Tick Prevention? Yes No Does your dog have medical issues? Yes No If so, is he/she on any prescription medicines? Yes No What training have you done with your dog? Puppy class only Basic adult obedience class Private, in-home training No 'formal' training so far Where and with whom did you train? Describe the problems you're having with your dog Describe a 24 hour day in your dog's life Thank you.
Canine Questionnaire
Owner Information:
Your Name(s):
Phone: 1 2
Email: 1 2
How many pets do you have?
Dog(s) 1 2 3 Other
Cat(s) 1 2 3 Other
Bird(s) 1 2 3 Other
Other
How many dogs have you owned/lived with?
This is my first dog ever This is my first dog as an adult I've had several dogs
If you have a pure bred dog, why did you choose that breed? Who is your breeder and what is their website address?
What phrase best describes the choice of this particular dog?
Only one to choose from Breeder chose dog for me Dog chose me Felt sorry for dog Always wanted this breed
Dog Information
Dog's Name Breed/Mix
Spayed/Neutered: Yes No
Age of dog when obtained? 2 to 6 months 6 months to 2 years 2–6 years over 6 years
Age of dog now? 2 to 6 months 6 months to 2 years 2–6 years 6–9 years over 9 years
Where did you get this dog?
Breeder Nearby shelter Nearby rescue group On line rescue/shelter Pet store Friend Stray
How many hours/day does your dog spend alone while you work?
Zero, never alone Why? Less than five hours Less than eight hours More than eight hours
When you are at work, your dog
Goes out with you at midday Has a dog walker at midday Goes out in a 'play group' Goes to doggie daycare Has a dog door to a fenced yard Waits until you get home
When you're not at home, your dog is
In a crate In one room only Free in house In the yard
Where does your dog sleep?
With you in bed On a dog bed in bedroom Where he/she pleases In crate in bedroom In crate in kitchen
Who is your veterinarian? Name of practice? Town?
Date of and reason for your pet's most recent visit to a veterinarian
Rabies Vaccine date
Distemper complex
Heartworm Prevention? Yes No Tick Prevention? Yes No
Does your dog have medical issues? Yes No
If so, is he/she on any prescription medicines? Yes No
What training have you done with your dog?
Puppy class only Basic adult obedience class Private, in-home training No 'formal' training so far Where and with whom did you train?
Describe the problems you're having with your dog
Describe a 24 hour day in your dog's life
Thank you.
Do you CLICK with your dog?
