Please make sure that you fill out the entire
form, per dog if you're a family that has more than one dog.
Please allow up to 12-hours for a response
to the form via email initially. If you need to speak with someone
directly, please contact Jessie Riggs on her cell at (530) 867-5727.
Owner
Information:
First Name:
Last Name:
Email Address:
Home Phone:
Cell Phone:
Pet Information:
Pet Name:
Breed of Dog:
Date of Birth:
Where did you get your dog?
Where does your dog stay during the day?
Where does your dog stay at night?
Give the date (as close as possible) when your dog last visited
a daycare facility
What was the name of the daycare?
Pet Behavior Information:
Describe your pet's behavior the last time you took him/her to
a daycare facility or boarded him/her:
When was the last time you took your dog to a friend's house that
they didn't know?
Describe your dog's reaction when he/she meets new dogs in an intimate
setting and not a dog park type of setting?
Does your dog stay under voice command and line of sight at all
times whether he/she is swimming, walking, etc?
Does your dog play with others in a dog park setting?
Describe your dog's mannerisms when he/she meets new dogs or people
when out walking?
How does your dog behave around large dogs or dogs that like to
rough-house?
Is there any particular breed of dog that your dog doesn't like
or is afraid of?
How does your dog react to strange men?
How does your dog react to being disciplined?
What forms of discipline do ou use?
Has your pet undergone any kind of basic training? If so, who was
the trainer?
Has your dog ever biten you or anyone else including other dogs?
If so, what was the circumstances behind the event?
How does your dog react when someone takes away his/her bone, favorite
toy, etc.?
How does your dog react if another dog tries to take anything away
from him/her?
How does your dog react when other dogs want to play rough with
him/her?
How well does your dog ride in the car with other dogs?
Does your dog have any sensitive areas on his/her body?
Is there any exercise limitations on your dog?
Is your dog crate-trained or used to sleeping in a crate?
Is your dog used to free feeding?
Is your dog used to using a doggie door?
Have you seen your dog eat another dog’s stool or another
animal’s stool?
Does your dog have a problem in any of the following areas:
a. Barking: yes
no
b. Jumping: yes
no
c. Biting: yes
no
d. Growl if disturbed when sleeping: yes
no
e. Humping other dogs: yes
no
f. Chasing cars: yes
no
g. Charging towards other people or strange dogs: yes
no
Does anything frighten your dog besides thunder, i.e. if someone
wears a hat, raises their hand in an effort to pet them on the head,
etc.?
How does your dog do around cats?
What games does your dog like to play?
Does he/she enjoy swimming?
If there’s anything that you feel we need to know about your
dog that wasn’t asked above, please feel free to list.
Please list the following keywords or commands that you use for
the following situations:
a. Using bathroom (“potty”, “pee”, “poop”,
etc.):
b. Going bye-bye (“let’s go”, “bye-bye”):
c. Wanting him/her to leave something alone (“leave it”,
“drop it”, “don’t touch”):
d. Treats (“cookie”, “yummies”, “bone”):
e. Going to sleep for the night (“let’s go night-night”,
“night-night”, “it’s nighttime”):
f. Getting into the car (“up”, “jump”, etc.):
Is there any other commands for various other situations, please
list.
