K9 History Form

Name*

First Last

Phone*

Email*

General Background

Pet's Name*

First

What type is your dog?*

I am this dog's*

Owner
Handler
Hauler/Transporter

What type of work does your dog do?*

Examples: guide dog, field trial, agility, patrol, detection, etc.

What is the status of your dog's career?*

Examples: pup, in training, active, retired, etc.

What is your dog's length of service/competition?*

Any history of bite training?*

Yes
No

How are they with people?*

Examples: cooperative, avoidant, indifferent, defensive, offensive, etc.

Will they follow English commands and or cues from people other than their handler?*

Yes
No

Are they reactive to other dogs?*

Yes
No

Is your pet muzzle trained and/or do you recommend we muzzle them for rehab purposes?*

What type of reward can we use for rehabilitation purposes?*

Examples: toy, praise, food, etc.

Are you bringing a specific reward for us to use?*

Yes
No

Does your dog have any specific handler behaviors, triggers or environmental cues we need to avoid?*

How did you hear about the VSC K9 ReC Center? (Examples: website, event, personal referral)*

website
event
personal referral

Medical History

Does your dog have any existing health conditions?*

Has your dog had any prior surgeries?*

If yes, please list type and general date.

What medications and/or supplements is your dog currently taking?*

Has your dog done any physical rehabilitation in the past? Or are they currently in physical rehabilitation?*

Has your dog done any fitness or conditioning work specifically in the past?*

What types of specific actions do they do on a daily basis?*

Examples: jumps, climbing, diving, etc.

Does your dog have any allergies to food or medications?*

Is your dog up-to-date on core (Rabies, DA2P) and elective (e.g., Lepto, Lyme, Flu) vaccines?*

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Email

This field is for validation purposes and should be left unchanged.

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General Background

Medical History

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