ID#______
Canine Personality Profile
Dog’s Name: ______Breed: ______Purebred: Y / N Age: ______Gender: M / F
Veterinary Clinic: ______Name records are under: ______
Altered: Y/N Current on vaccines? Y / NLast seen at a clinic? ______
Reason forsurrender?______
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What would need to happen for you to keep the dog in your household?______
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How long have you owned the dog? ______
Where did you obtain the dog? (check/circle one) □ This facility □ Other shelter □ Breeder □ Found
□ Pet store □ Giveaway □ Friend □ Rescue group □ Other: ______
Facility/Organization/Name:______Tel #: ______
To your knowledge, how many homes has the dog had before living with you? ______
Does the dog have any current, previous or recurring medical problems? ______
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Behavioral problems? ______
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Have there been any recent lifestyle changes?(circle/check all that apply) □New house □ New roommate
□ New pet □ New baby □ Construction nearby □ Change in your work habits
Has the dog ever:(circle/check all that apply)
□ Bitten □ Snapped □ Growled □ Lip Lifted
Who/what was involved?(circle/check all that apply)
□ Food □ Rawhide □ Toys □ Strangers □ Children □ Adults □ Other animals □ Restraint
Explain circumstances: ______
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How many hours a day is the dog left alone?(circle/check all that apply)
□ More than 10 hours □ 8-10 hours □ 5-8 hours □ 0-4 hours □ Never left alone
Where is the dog kept when you’re not home? (circle/check all that apply)
□ Always outside □ Sometimes outside □ Crate/kennel □ Loose in the house □ In garage
□ Confined to a room □ Kept chained outside □ Dog door to outside □ In basement
How much playtime/one on one interaction does the dog get per day? ______
Activity level of dog? (circle one) Low Moderate High
How does your dog usually behave toward the following? (Please check ALL that apply):
Column1 / Column2 / Never Encounter / Friendly / Afraid/Nervous / Growls / BitesPeople your dog knows
Men
Women
Children
Unfamiliar People
Men
Women
Children
Other Animals
Male Dogs
Female Dogs
Cats
Livestock
Are there any particular people or things that the dog appears to be afraid of?(circle/check all that apply)
□ Men □ Dogs □ Cars/truck □ Strangers
□ Loud noises □ Children □ Women □ Cats
□ Thunderstorms □ Vacuums/brooms □ People in uniform
□ Water □ Fireworks□ Other______
Based on your experience with this dog, do you recommend it live with children ages: (circle/check all that apply)
□ 0-6yrs □ 7-12yrs □ Over 13yrs
Basic obedience commands my dog knows: (circle/check all that apply)
□ Sit □Stay □ Come □Lay down □Heel Housetrained? Y/N Crate trained? Y / N
How often did you take your dog outside to go to the bathroom? ______
My dog is:(circle all that apply)
friendlyplayfulenergeticvocal used to brushing
calmnervousanxiouschewer digger
protective aggressiverides well in a car walks on leash
shyjumperused to nail trimming
What type of food is the dog currently eating? (brand, wet/dry?)
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Anything else you would like a potential adopter to know about this dog?
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