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BEHAVIOR MODIFICATION HISTORY FORM
Please fill out the following to the best of your ability. The more information you are able to give us that pertains to your dog, the better we will be able to help you.
= mandatory field
DOG INFORMATION
DOG'S NAME
KENNEL NAME (IF APPLICABLE)
NAME
/
/
DOG'S DATE OF BIRTH
DOG'S AGE PRESENTLY
months
DOG'S AGE WHEN BROUGHT HOME
months
HOW LONG HAVE YOU HAD THIS DOG?
months
AGE
BREED
WEIGHT
BODY CONDITION SCORE
CLICK HERE FOR GUIDE
DESCRIBE DOG'S COAT COLOR
DESCRIPTION
GENDER OF DOG
REPRODUCTIVE STATUS
HOW OLD (IN MONTHS) WAS DOG WHEN SPAYED/NEUTERED?
(LEAVE BLANK IF NOT APPLICABLE)
HAS THIS DOG BEEN BRED?
REASON FOR NEUTERING/SPAYING
BEHAVIORAL CHANGES AFTER NEUTERING/SPAYING
IF DOG HAS NOT BEEN BRED, DO YOU PLAN ON BREEDING HIM/HER?
IF DOG HAS BEEN BRED, HAVE THERE BEEN BEHAVIOR CHANGES AFTER BREEDING?
REPRODUCTIVE STATUS
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