Canine Personality Profile - Humane Society of Southern Wisconsin

Your Contact Information

Name *

Street address *

City *

State *

Zip *

E-mail *

Phone Number *

Your Dog's Information & Background

Dog's Name *

Dog's Age *

Dog's Breed *

Why are you looking to surrender your dog? *

How long have you owned your dog? *

Where did you get your dog from? *

What food does your dog currently eat? *

Please list the brand (Iams, Purina, etc.) and type of food (dry, wet, etc.).

My Dog Currently Lives With/Has Lived With: *

Dogs
Cats
Other Pets
None of the Above

If you answered 'Other Pets' above, please list them here.

If your dog currently lives/has lived with other dogs, please describe them.

Please list the breed(s) and/or size(s) of the other dog(s) they have lived with.

My Dog Cannot Live With: *

Dogs
Cats
Other Pets
None of the Above

If you answered 'Other Pets' above, please list them here.

Has your dog lived with children? *

Yes
No

If you answered 'yes' above, what ages of children has your dog lived with?

Does your dog enjoy being around children? *

Yes
No

Please explain your answer to the above question. *

Is your dog housetrained? *

Yes
No

If you answered 'no' above, please explain.

If you answered 'yes' above, is your dog on a routine? And how do they let you know they need to go out?

Is your dog crate trained? *

Yes
No

When is your dog in their crate? *

For example - "Only when I am gone" or "When I am gone and when I am asleep"

How many hours is your dog typically left alone? *

What form(s) of exercise does your pet get? *

When your dogs is outside, what are they confined by? *

Your Dog's Personality

I Would Describe my Dog as: *

A Family Dog
For Adults Only
One Person Dog
Outside/Farm Dog

Is your dog comfortable being alone? *

Yes
No

If you answered 'no' above, what does your dog do when left alone?

Please describe the behaviors your dog exhibits when left alone.

How does your dog react to/behave at the vet? *

Can you easily take bones/treats/food away from your dog? *

Yes
No

If you answered 'no' above, please explain.

Please describe what your dog does when you try to take bones/treats/food away from them.

Does your dog like playing with toys? Please describe. *

How would you describe your dog's temperment? *

If you answered 'other' above, please explain.

Does your dog do any of the following behaviors? *

If you answered 'other' above, please explain.

Does your dog get nervous in any situations or at any places? If so, explain. *

Is your dog afraid of any of the following? *

If you answered 'other' above, please explain.

Does your dog know any of the following commands? *

If you answered 'other' above, please explain.

Has your dog ever snapped or bitten? *

Yes
No

If you answered 'yes' above, please explain.

Please describe the situation(s), circumstance(s), and all details surrounding any bite(s).

Your Dog's Medical History

Does your dog have any ongoing medical concerns? *

Yes
No

If you answered 'yes' above, please explain.

Please describe the situation(s), circumstance(s), and all details surrounding any bite(s).

Is your dog spayed or neutered? *

Yes
No

Is your dog up-to-date on vaccinations? *

Yes
No

Additional Information

Is there anything else that you would like us to know? *