Dog Medical and Personality Profile
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| Please answer as completely and precisely as you can. Please submit this form once for each dog. Truthful answers will not affect your status as a PAWS client. |
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Client Name:
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E-mail Address:
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Dog's Name:
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Breed:
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Color:
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Sex:
| Male Female |
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Spay/Neuter:
| Yes No |
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Approximate Date of Birth:
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Approximate Weight:
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Name of Veterinarian:
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Name of Clinic:
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Clinic Address:
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Clinic Phone Number:
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Approximate date of last visit to vet:
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Does your pet have an ongoing medical condition?:
| Yes No |
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If yes, please explain:
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Is your pet currently taking medication?:
| Yes No |
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If yes, what type?:
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Date of last fecal examination:
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| PLEASE, contact your veterinarian for the following information: |
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Date of last DHLPP (Distemper):
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Date of last RV (rabies):
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| Dog Personality Profile |
| Diet |
Does your pet require a special kind of food?: |
Yes
No |
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If yes, please describe the special dietary requirements:
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If yes, was this recommended by your veterinarian?:
| Yes No |
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How often is your pet fed?:
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Is there any type of food this dog will not eat?:
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| Behavior |
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Dog is:
| Housebroken
Occasionally has accidents
Paper trained
Not housebroken |
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How does your dog ask to go out?:
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Is your dog crate trained?:
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Yes No |
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How many times a day is the dog exercised?:
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For how long?:
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How long is the dog left alone on a daily basi (without human companionship)?:
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When the dog is left alone, is she/he kept inside?
| Yes No |
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How does she/he react to being alone for several hours?:
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Would you describe this dog as:
| Family dog
One-person dog
Good for senior citizens
Good for children
Ages of Children:
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Check all that best describe this dog:
| Shy
Affectionate
Hyper
Playful
Protective
Noisy
Aggressive
Quiet
Needs a lot of attention
Needs a lot of exercise |
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Dog has lived with:
| Cats
Caged birds
Children
Other animals |
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If dog has lived with children, what ages were the children?:
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If dog has lived with "other animals", what type of animals?:
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Was living with other animals successful:
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Is the dog afraid of anything (thunder, cars, etc)?:
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Does the dog respond to his/her name?:
| Yes No |
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Where does dog sleep at night?:
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How do you keepthe dog confined to your property?:
| Fenced area
Cable/chain
No fence |
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Does your dog jump fences:
| Yes No |
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Height of your fencing:
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Fencing type:
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The dog's favorite activities are:
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Dog has had:
(check those that apply)
| Training
Obedience classes
Home training
No training |
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Commands:
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The dog:
| Comes when called
Walks politely on a leash
Tolerates grooming
Likes riding in car |
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The dog is overly protective of:
| Family
Its food/toys
Own property |
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Has this dog ever been kenneled:
| Yes No |
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How was kenneling:
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Bad habits to watch for:
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Favorite games/toys:
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Have you ever had any behavioral problems with the dog?:
| Yes No |
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If yes, under what circumstances?:
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Has the dog ever acted in an aggressive manner?:
| Yes No |
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If yes, under what circumstances?: | |
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Has the dog ever bitten anyone?:
| Yes No |
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If yes, under what circumstances?: | |
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Other comments:
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For
verification purposes, please enter the numbers you see in the image
below: |
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