Please fill out all the fields and hit the submit button. We will contact you shortly. Thank you! Owner InformationName* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Work Phone*Email* Dog InformationDog's Name*Breed*Date Aquired DogSex*Age*Is dog spayed/Neutered?* Yes No Age spayed/neutered:Where did you get your dog?Knowledge of dog's history:Behavioral InformationDo you have children? Yes No If yes, what are their ages and sex?Does your dog like children? Yes No How does your dog behave around children?Are there other animals in your home? Yes No If yes, what type, sex and age of each:How does your dog get along with other resident animals?Has your dog been around other dogs? Yes No If yes, how did your dog respond?Is your dog afraid of any specific items/noises? Yes No If yes, what?How does your dog respond to strangers in your yard/home?How does your dog respond to strangers in an unknown location?Does your dog ever bark or growl at people passing outside your home or yard? Yes No Sometimes Are there any kinds of people your dog automatically fears or dislikes? Yes No If yes, please explain:How does your dog respond to new dogs?How does your dog respond to puppies?Where is your dog kept when you are not home?Is your dog destructive in your house? Yes No Does your dog show any signs of anxiety when you leave? Yes No If yes, what are the signs?How does your dog act when you get home?How much regular, structured exercise does your dog get?Has your dog ever growled or snapped at anyone? Yes No If yes, how many times and please describe each:Has your dog ever bitten anyone? Yes No If yes, how many times?Was the skin broken?Please explain the circumstances:Does your dog have a tendency toward any of the following behaviors? Mouthing House soiling Barking Digging Jumping If yes, please explain:Has your dog ever growled or snapped at anyone who has taken food or toys away? Yes No If yes, please explain:How does your dog respond if another animal approaches your dog's food or toys?Does your dog play with toys? Yes No If yes, what are his/her favorite kinds?What are your dog's favorite games?Does your dog play with other dogs? Yes No If yes, how often and with what breeds of dogs?Health and GroomingDoes your dog have a problem with fleas? Yes No If yes, how are you treating them?Does your dog have any known physical problems? Yes No If yes, what kind?Are there any restrictions that need to be placed on your dog's physical activities or movements? Yes No If yes, what restrictions?Does your dog have allergies? Yes No If yes, how are you treating them?Does your dog like to be brushed? Yes No How does your dog react to having his/her toe nails clipped?Has your dog ever growled or snapped while having his/her nails trimmed? Yes No Can you touch all parts of your dog's body? Yes No Can other people touch all parts of your dog's body? Yes No Has your dog ever growled or snapped at you or any other person while being touched? Yes No If yes, please describe:What are your dog's favorite petting spots?TrainingHas your dog ever had any formal obedience training? Yes No If yes, when and where?What obedience commands and/or tricks does your dog know?How responsive is you dog to commands?Does your dog know a bathroom command? Yes No If yes, what is it?Any other info about your dog:4 + 2 =*