intake. General Info. Socialization. Aggression. Food and health. Current Abilities. Emergency Info. Name * First Name Last Name Dog's Name Dog's Age * How long has dog lived in your home? * Dog's Breed * Is your dog spayed/neutered? * Yes No Housebroken? * Yes No Crate Trained? * Yes No How many dogs live in your home? * 1 2 3 4+ How much does your dog socialize with other dogs? * Never Has in the past but not regularly Occasionally Frequently Daily How much time does your dog spend with children? * Never Rarely Occasionally Frequently Daily Lives with children Has your dog ever shown aggression toward another dog? * Yes No If yes, please explain Has your dog ever shown aggression toward children? * Yes No If yes, please explain Has your dog ever shown aggression toward men? * Yes No If yes, please explain Has your dog ever shown food aggression? * Yes No If yes, please explain Dog Food * Food Amount * Feeding Schedule * Morning Midday Evening Any food allergies? * Yes No If yes, please explain Any additional food information Any special health needs? * Yes No If yes, please explain Any medications? * Yes No If yes, please specify medication name, reason, and how it is given For the following items, please rate your dog's current abilities on a scale of 1-10 (1 = does not know at all; 10 = follows command consistently). Come 1 2 3 4 5 6 7 8 9 10 Sit 1 2 3 4 5 6 7 8 9 10 Down 1 2 3 4 5 6 7 8 9 10 Heel 1 2 3 4 5 6 7 8 9 10 Place 1 2 3 4 5 6 7 8 9 10 When walking on a leash, your dog... Pulls my arm off! Is very excited and pulling gently Is a gentleman/lady, always walking at my side Needs to be pulled to get anywhere Is very aggressive Has never seen a leash Emergency Contact (if you are unavailable) * First Name Last Name Emergency Contact Phone Number * (###) ### #### Vet Name Vet Phone Number (###) ### #### Thank you!