This Pet Profile Is Required to Assist Canine Connection in Understanding Your Dog's History

DOG PROFILE

This pet profile is required to assist Canine Connection in understanding your dog's history, personality, and temperament. Please fill out one form for each dog in your family. Pet owners are responsible for providing updated information to Canine Connection.

Owner (1):______E-mail Address:______

Mobile #:______Home Phone: ______Office Phone:______

Home Address:______City:______State:______Zip:______

Owner (2):______E-mail Address:______

Mobile #:______Home Phone: ______Office Phone:______

Who referred you, or how did you hear about us?______

Emergency Contacts (other than household member): Please check the box if they have permission to pick-up.

Name:______Phone:______q Alternate Pick-Up

Email:______

Name:______Phone:______q Alternate Pick-Up

Email:______

Name:______Phone:______q Alternate Pick-Up

Email:______

Evacuation Contact: This person is designated to pick-up your pet in the event of a hurricane or other evacuation from June1st through November 30th. Pets who do not have an emergency pick-up may not board at Canine Connection.

Name:______Phone:______Relation:______

Email:______

Name:______Phone:______Relation:______

Email:______

Dog Information:

Name: / Sex:
q Male q Female / Breed: / Weight (lbs):
Color: / Distinctive Markings:
Approximate Age or Date of Birth: / Spayed/Neutered:
q Yes or q No

Veterinarian Information:

Vet Office Name:______Vet Name:______

Office Phone:______Fax #: ______

Address:______City:______State:______Zip:______

What type of flea prevention do you give your pet? All pets are required to take routine flea prevention before using our services.

______

Can your dog go up and down stairs? q Yes q No If No, why:______

Can your dog climb or jump? q Yes q No How high:______What restrictions do they need

because of this?______

______

Your Dog's History:

How long has your dog been in your life?______

How and where did you acquire your dog?______

Do you have knowledge of your dog's prior history?______

Has your dog been to the dog park and/or played in other larger groups of dogs? q Yes q No

How do they behave in this setting?______

Has your dog ever been to daycare? q Yes q No How did he/she do?______

Has your dog ever been kicked out of daycare? q Yes q No Why?______

Has your dog ever boarded overnight? q Yes q No How did they do?______

______

Has your dog ever bitten a person? q Yes q No Is this a re-occurring issue?______

If "yes", what were the circumstances?______

Has your dog ever bitten another dog? q Yes q No Is this a re-occurring issue?______

If "yes", what were the circumstances?______

Your Dog's Health:

Please list all health issues for your dog, and how these issues are handled:______

______

______

Is your dog heartworm positive?* q Yes q No Does your dog have hip dysplasia? q Yes q No

Does your dog have allergies? q Yes q No q Unsure What are they?______

Does your dog have any sensitive areas on their body?______

Is your dog prone to hot spots? q Yes q No What do you use to treat this?______

Has your dog had gastroplexy (bloat prevention surgery)? q Yes q No

Are there any restrictions that should be placed on your dog's activity?______

______

Your Dog's Behavior:

Does your dog have storm or thunder anxiety? q Yes q No What do you use to help this? ______

How do they react during a storm?______

Is your dog afraid of any specific item or noise? Please explain:______

Are there people your dog automatically fears or dislikes?______

How does your dog react to puppies?______

Does your dog have problems in any of the following areas:

Mouthiness** q Yes q No Escaping q Yes q No

Barking q Yes q No Digging q Yes q No

Toy Possession q Yes q No Eating foreign objects or feces q Yes q No

Food Possession q Yes q No Separation Anxiety q Yes q No

Comments:______

______

*We recommend restricted activity for heartworm positive dogs, as do most veterinarians. Physical exertion can increase the rate in which heartworms can damage the heart and lungs, and may also cause a potentially fatal blood clot or further complications.

**Mouthiness refers to your pet lightly biting or chewing to get attention or communicate.

Is your dog reactive in any of these situations?(if "yes" is selected, please write details below)

On leash q Yes q No When bumped by other dogs q Yes q No

In a kennel q Yes q No When sniffed by other dogs q Yes q No

Through a barrier q Yes q No When touched in a certain area q Yes q No

At doors/gates q Yes q No Please specify:______

When you reach towards their neck/collar? q Yes q No

Comments:______

______

Is your dog a picky eater? q Yes q No Does your dog have a sensitive stomach? q Yes q No

Rate your dog's energy level "1" being very mellow and "10" being hyper:______

Has your dog had any formal obedience training?______

What word or saying to you use for "potty"?______

Grooming Your Dog:

How does your dog react to (please be as specific as possible):

Being in the tub?______

To water?______

Being brushed?______

Ear cleaning?______

The blowdryer?______

Clippers?______

Nail Trims?______

Close, elongated contact with people?______

How is your dog on a grooming table?______

Does your dog need to be muzzled for any grooming procedures?______

Does your dog require sedation before grooming? q Yes q No What type?______

Etc.

Is there anything else you would like to tell us about your dog that will ensure he or she has a wonderful time with his or her four-legged friends at Canine Connection?

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