DOG HISTORY FORM

Hello! We are so excited to get to know your best friend a little better. This history form is to assist us in gaining a comprehensive understanding of your dog’s behaviors and how best to communicate with them.

Knowledge of any concerns or issues you have with your dog will help us to accommodate your dog for a safe and successful daycare experience!

Dogs do not “pass” or “fail” the evaluation. Rather, it helps us to understand better where we should start and how we might be able to help your dog adjust and thrive at Canine Acres!

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Name

Email Address

Phone Number

What is your dog’s name?*

What breed is your dog?*

You can put "Unknown." If your dog is mixed and you know any of the breeds, please list them.

Does your dog have any medical conditions/concerns (allergies, hip dysplasia, injuries, etc.)?*

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Is your dog currently on any medications? If yes, please list the medications and the reason for the medications.*

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Where did you get your dog?*

Rescue / Humane Society

Breeder

Other

How long have you had your dog?*

Less than a year

1-3 years

3+ years

Other

Is your dog neutered/spayed?*

Yes

I plan to.

If you answered "No" to the previous question- please include a brief description of why, whether it is health related, age related, intention to breed, or whatever the reason may be.

We are hoping to gain more insight into the “why not” for our customer base. Thank you for your help!

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Why are you signing your dog up for daycare?*

Check all that apply.

For exercise and better health

For mental stimulation

To make more four-legged friends (socialization)

To build confidence

To diffuse or deplete too much energy

To correct a concern/issue

To reduce time spent home alone

For more attention during the day

For extra cuddles and affection.

Other

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Behavior + Training

Has your dog been to another pet *daycare before?*

*Daycare supervised by a dog care facility. This does not include dog parks.

Yes

If they have attended a daycare, how did that go? Did you receive any reports about your dog's behavior? What did they convey or reveal?

Daycare supervised by a dog care facility. This does not include dog parks.

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Do you take you dog to a dog park? If yes, has it been a positive or negative experience for your dog?*

Check all that apply.

No, my dog has never gone to a dog park with other dogs.

Yes, and only positive experiences

Yes, and primarily negative experiences

Yes, and both positive and negative experiences

Other

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Has your dog ever stayed at a boarding facility?*

Yes

Is your dog crate-trained?*

Yes

Currently being trained

Rate your dog's energy level.*

Full Time Couch Potato

High Energy Never Endss

Have you sought any professional dog training?*

Check all that apply.

No, I trained my dog on my own.

Yes, with a professional certified trainer

Local community class

Group/puppy class

Yes, for specialized skill training (ex. hunting, therapy, institutional companion)

Other

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Please describe how you discipline your dog if they are misbehaving. List any tools you use to correct behavior (ex: shock collar, bark collar, muzzle, treats, etc.)*

Examples of discipline may include: physical correction, redirection, positive reinforcement, negative reinforcement, time outs.

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Training Cues your dog knows:*

Check all that apply.

Sit

(Lay) Down

Stay

Leave It

Drop It

Heel

Come

Crate/Kennel

Other

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Temperament at home:*

Check all that apply.

Shy

Fearful

Aggressive

Reactive

Nervous

Skittish

Anxious / separation anxiety

Attention Seeker

Quiet

Rambunctious

Relaxed

Vocal

Other

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Concerns/Questions

Does your dog have any triggers?*

Check all that apply.

Dogs

Humans

Prey

Cars

Male/ Dominant dogs

Mail carrier or delivery trucks

None

Other

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Any concerns or current issues your dog has.*

Check all that apply.

None. You are about to meet the perfect dog!

Food Agression

Toy Possessiveness

Digger

Jumper

Barking

Escape Artist (slips collars, runs away, etc)

Climbing professional - can scale fences

Bite History with people

Bite history with other dogs

Growls or snaps at dogs

Growls or snaps at people

Has been attacked

Humps

Other

Write here

Any questions for us or other information we should know?*

Write Here

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DOG HISTORY FORM

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Behavior + Training

Full Time Couch Potato

High Energy Never Endss

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Concerns/Questions

History Form Successfully Submitted - PENDING APPROVAL

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