Puppy Raiser’s Survey
Date ______
Age of Dog ______
Name of Puppy Raiser ______
Name of person providing respite? ______
Home Number ______Cell Number ______
Date leaving ______Date returning ______
Do you give your dog access to your entire house while you are at home? Check one.
______Yes ______No ______Limited access
Does your dog sleep in a crate at night? ______Yes ______No
If not in a crate at night, where does your dog sleep? ______
Do you allow your dog on the furniture?
______Yes ______No ______Only certain furniture
Describe how you manage your dog during your mealtimes or food prep times:
______
______
Where do you leave your dog while you are gone? ______
How does your dog behave while in your house? ______
______
Does your dog counter surf? ______
Does your dog chew on things other than his toys? Please explain. ______
______
Does your dog eat things that are unusual or that he shouldn’t? Please explain. ______
______
Is your do reactive to sounds in or outside your house? What does he react to? ______
______
How does your dog react to visitors coming into your home? ______
______
What things does your dog like to do while he is in the house? ______
______
Is there anything your dog is fearful of or doesn’t like? ______
______
Where does your dog ride in your car? ______
How does your dog get along with other dogs in your household? ______
______
How does your dog get along with new dogs when allowed to play? ______
______
Does your dog get excited when he sees another dog? Explain. ______
______
Does your dog growl, lunge or bark when he sees another dog? Explain. ______
______
Does your dog get upset when another dog tries to take his toy or chewy? Explain.
______
Does your dog live with other animals? List species. ______
______
Has your dog been exposed to any other species of animals? ______
______
What food is your dog eating? ______
How much is he eating and how often? ______
What is your procedure before your dog gets his meals? ______
______
Is your dog currently on any medication or supplements? What and what dosage/amount?
______
Day of month your dog receives flea/tick control and heartworm preventative ______
Has he received it this month? ______
Does your dog have any ongoing medical issues? ______
______
Who is your dog’s veterinarian at Cville Vet Hospital? ______
Does your dog have exercise limitations? ______
______
What does your dog enjoy doing for exercise? ______
______
How much exercise per day does your dog need to be calm and quiet in the house? _____
______
What is your dog’s favorite toy? ______
Does your dog have a favorite treat and what is it? ______
______
Besides food, what else does your dog love that could be used as a reinforce? Please describe.
Examples: Fido loves to carry sticks and/or Fido loves a belly rub. ______
______
______