Incoming Canine Profile

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1 Dog and Household Information Incoming Canine Profile 1. Dog s Name: 2. Sex: MALE FEMALE 3. Age: 4. Breed: 5. How long have you owned this dog? 6. Spayed or Neutered? YES NO 7. What s your relationship to this dog? 8. Where did you get this dog? 9. Reason for surrendering this dog? 10. Has your dog bitten within the last 10 days? YES NO 11. Has your dog ever bitten and broken skin? YES NO 12. Including yourself, how many people of the following ages live in your house? Age Range (years) Female Male 13. What other animals did your dog live with? NONE CATS DOGS OTHER: 14. How does your dog usually behave toward the following? Please check the boxes People your Dog Knows Unfamiliar People Animals your dog knows Dogs Cats Unfamiliar Animals Dogs Never Encounter Friendly Afraid teeth/growls Snaps Bites None of These Cats

2 15. Does your dog usually uncontrollably chase or attempt to chase any of the following? Please circle all that apply. Joggers Bicycles Skateboarders/rollerbladers Cars/Motorcycles Outdoor Cats Squirrels/Other Small Animals Birds None Other (please describe) 16. How does your dog usually react when you or another family member does the following? Please check boxes. Bathe Never Tried Enjoys Allows Afraid Teeth/Growls Snaps Bites None of These Brush Wipe Feet 17. How does your dog usually react when an unfamiliar person approaches or enters the yard or house? Please circle. Friendly Afraid Barks Teeth/Growls Snaps Bites None of these 18. Where does your dog spend most of his/her time? 19. Where is your dog when left home alone? 20. When left alone, does your usually show any of the following behaviors? Please circle all that apply. Destroys household items Urinates/Defecates Bark Cry None of these 21. When your dog plays does he/she typically Please check all that apply. Jumps Growls Barks Bites lightly Bites hard None of these 22. What toys does your dog like? Balls Frisbee Plush Squeaky Tug Toy None Other (please describe) 23. What games does your dog like? Fetch Tug Chase Wrestling None Other (please describe) 24. Is your dog afraid of anything? YES NO Yes (Please describe) 25. Please tell us your dog s bad habits Where does your dog usually sleep overnight? Cage Floor Dog bed Couch Owner s bed Other (Please describe) 27. What commands does your dog know? No Commands known Sit Stay Down Come Heel Give Paw Other (Please describe) 28. Has your dog been to training classes? YES NO

3 29. Has your dog escaped your property 2 or more times in the last 6 months? YES NO 30. Is there any report of your dog ever inflicting a serious bite to a person? YES NO DON T KNOW 31. Has your dog ever attacked another dog resulting in a severe injury or death to another dog? YES NO DON T KNOW 32. Has your dog ever attacked another domesticated animal species (cats or livestock but not pocket pets like hamsters, guinea pigs, ect.) resulting in severe injury or death to another animal? YES NO DON T KNOW 33. Please check the appropriate box if your dog has ever shown any of the following aggressive behaviors towards men, women, children, dog or another domesticated animal species (cats or livestock but not pocket pets like hamsters, guinea pigs, ect.) Do not include aggressive behaviors directed toward a veterinarian or groomer. Dog Other domesticated animal species Teeth/Growls Snap Bite None of These Do Not Know 34. If a snap or bite to men or women was checked, did the snap or bite take place while breaking up a dog fight or while a dog was in severe pain? YES NO 35. If a snap or bite to children was checked, did the snap or bite take place while breaking up a dog fight or while a dog was in severe pain? YES NO 36. Please explain the circumstances of the bite or snap. If you checked more than one bite in the table above, please explain the circumstances of every snap or bite. 37. Is your dog housetrained? YES NO PARTIALLY NO/Partial (Please explain)

4 38. When does your dog s housetraining accident most often happen? When not supervised When not kept on a schedule Dog is too excited Dog signals to go out and is ignored While sleeping 39. Are there any places on your dog s body that they don t like being touched? 40. If any aggressive behavior to men, women or children was checked in the table above, please answer the following questions. If does not apply, skip the table. Was the aggressive behavior over food? Was it over bones, rawhides or chews? Was it over toys? Was it over stolen objects? Was it when the dog was disturbed while sleeping? Was it when an adult or child handled the dog (brushing, handling feet, bathing, teeth brushing, ear cleaning, ect. But do NOT include reaction to vet or groomer)? Was it when an adult or child entered the house or yard? Was it when an adult or child approached or reached toward the dog? YES NO YES NO YES NO 41. Does your dog see a veterinarian at least once a year? YES NO 42. Check if your dog has ever shown any of the following behaviors when handled by a veterinarian or groomer. Examine (including heart and ears) Restrain Administer Shots Trim Nails Take Blood Never Done Show Teeth/Growl Snap Bite None of These 43. Does your dog have to be muzzled at the veterinarian? YES NO 44. Does your dog have any past or present medical conditions? YES NO If YES, please describe: 45. Is your dog currently on any medication or special diet? YES NO If YES, please describe: 46. What type of food does your dog eat? DRY Wet/Canned Table Scraps Brand: 47. How often do you feed your dog?

5 48. Please feel free to tell us any additional helpful comments. SPCA Tampa Bay is an open admissions shelter. We accept the surrender of every owned pet. Once surrendered, we will make every effort to place your pet into a new home. We cannot, however guarantee that your pet will be adoptable due to a variety of factors, such as the pet s age, health and temperament. As such, please be aware that your pet may be humanely euthanized. SPCA Tampa Bay relies on the charitable support of the community. YOUR DONATION IS GREATLY APPRECIATED!

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