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.

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DOG INFORMATION

DOG'S NAME

KENNEL NAME (IF APPLICABLE)

NAME

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DOG'S AGE PRESENTLY

months

DOG'S DATE OF BIRTH

DOG'S AGE WHEN BROUGHT HOME

HOW LONG HAVE YOU HAD THIS DOG?

months

months

AGE

BREED

DESCRIPTION

BODY CONDITION SCORE

CLICK HERE FOR GUIDE

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WEIGHT

DESCRIBE DOG'S COAT COLOR

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GENDER OF DOG

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REPRODUCTIVE STATUS

HOW OLD (IN MONTHS) WAS DOG WHEN SPAYED/NEUTERED?

(LEAVE BLANK IF NOT APPLICABLE)

HAS THIS DOG BEEN BRED?

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REASON FOR NEUTERING/SPAYING

BEHAVIORAL CHANGES AFTER NEUTERING/SPAYING

IF DOG HAS NOT BEEN BRED, DO YOU PLAN ON BREEDING HIM/HER?

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IF DOG HAS BEEN BRED, HAVE THERE BEEN BEHAVIOR CHANGES AFTER BREEDING?

REPRODUCTIVE STATUS

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