Canine Initial Behavior Appointment

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Welcome to our Canine Initial Behavior Appointment Form. We look forward to working with you and your dog!

Important:

It is important to know that this form will require a lot of information and often can take between 15-20 minutes to complete. The information you provide is incredibly important to our team and we appreciate all efforts to fill this form out to the best of your ability.

After you fill this form out in its entirety, be sure to click Submit on page 5 of the form. You will then be directed to a confirmation page and a copy of your responses will be sent to the email you provide.

If you have submitted your form and have not heard back from our team within 72 hours OR you did not receive an email confirmation of your form submission, please reach out to us directly at [email protected].

Basic Information

Patient's Information

Patient's Name

Breed

Age

Gender

Coat Color

Date Of Birth

Owner's Information

Name

Address

City/Town

State/Province

ZIP Code

Primary Phone

Secondary Phone

Emergency Phone

Co-Owner's Information

Name

Primary Phone

Email Address

Regular Veterinarian

Regular Veterinarian Phone

Regular Veterinarian Address

How did you hear about us?

Household Information

Do you have more people that live in your household?

If yes, please list each of the members of your household with the following: Name, Age, Relation to Owner

Are there other people in regular contact with your dog (pet sitter, housekeeper, friends, etc.)?

If yes, please list these people with the following: Name, Age, Relationship to Owner

Are there other pets in the household?

If yes, please list these pets with the following: Name, Species, Gender, Current Age, Age at Adoption

Type of House

How long have you lived in this house?

Since adoption, how many houses has your dog lived in?

Does your home have a yard?

If yes, is your yard fenced?

If yes, how big is your yard? (approximate size)

What type of fence do you have?

How tall is your fence?

Acquisition Information

How long have you owned this dog?

Where did you obtain this dog?

How old was the dog when acquired?

List any behaviors of your dog's parents or litter mates (if known):

Describe any of your dog's previous homes (if known):

Please describe any known information given about your dog's behavior in previous homes:

Why did you choose this breed of dog? (coat, size, temperament, family dog, protection, etc.)

Why did you choose this individual dog?

We're here for emergencies 24 hours a day, 7 days a week!

Canine Initial Behavior Appointment

Basic Information

Household Information

How Are We Doing?

Get In Touch

Get In Touch

How Are We Doing?