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Dog History Form

Along with the PALS volunteer form, you will need to fill out this form for you dog if you wish for him or her to participate in pet therapy visits. There is an online form or one you can print and fill out on paper.

If you prefer a printable form please download the (pdf) or word document. Then mail or fax it to PALS. Thank you.

Owner / Handler

First Name
Last Name
Phone/Fax
Email

Dog's Bio

Name
Date of Birth (or estimated)
Breed(s) of Dog
Weight
Gender
 Female 
 Female-Spayed 
 Male 
 Male-Neutered 
Age of dog when acquired
How did you acquire your dog?
If the dog was NOT a puppy, what do you know of its history?
Has dog your attended obedience classes?
YES
NO
Highest Level achieved:
Which Commands will your dog obey? (check ALL that apply):
A) Sit
Usually
Sometimes
Rarely
A) Down
Usually
Sometimes
Rarely
A) Heel
Usually
Sometimes
Rarely
A) Come
Usually
Sometimes
Rarely
A) Stay
Usually
Sometimes
Rarely
A) Not Jump Up
Usually
Sometimes
Rarely
What type of collar do you most commonly use?
Is your dog used to walking on a leash?
YES
NO
Is dog fully house trained?
YES
NO
What is your dog's reaction to: (Check ALL that apply)
A) Other dogs:
Playful
Chases
Accepts Calmly
Nervous
Barks
Afraid
Aggressive
No Experience
B) Cats:
Playful
Chases
Accepts Calmly
Nervous
Barks
Afraid
Aggressive
No Experience
C) Children:
Playful
Chases
Accepts Calmly
Nervous
Barks
Afraid
Aggressive
No Experience
D) Vets Office:
Playful
Chases
Accepts Calmly
Nervous
Barks
Afraid
Aggressive
No Experience
Any other unusual reactions (i.e. men, uniforms, hats, people with canes)?
Has your dog ever growled, snapped at or bitten anyone?
YES
NO
If YES, please provide detailed explanation:
Which veterinary clinic do you use?
Currently rabies vaccinations are mandatory for all pets accepted into our program. Do you provide this protection for your dog?
 YES
 No, but I will, so that my application can be processed
Has your dog had surgery in the last 6 months?
YES
NO
If YES, please provide detaileds:
Is your dog on any medication?
YES
NO
If YES, please provide detaileds:
Has your dog ever been in a fight with another animal or had any experience which you may consider traumatic?
Might your dog be considered vocal?
YES
NO
Will your dog be quiet on command?
YES
NO
How does your dog fair riding in the car?
Bad
Average
Fair
Good
List things your dog does NOT like:
Please detail any behavioral problems you have encountered with your dog:
Is there any additional information you would like to add?