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Owner Questionnaire of Dog Life History and Behavior
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* Indicates required question
Date
*
MM
/
DD
/
YYYY
Owner Name
*
Your answer
Owner Gender
*
Male
Female
Other:
Dog Name
*
Your answer
Dog Date of Birth (mm/dd/yyyy) or age estimate (years)
*
Unkown
Other:
Dog Gender
*
Male
Female
Is your dog purebred?
*
Yes
No
I'm not sure
If your dog is of single-breed ancestry, please write their breed here.
*
Your answer
If relevant, what combination of breeds is your dog? If unknown, put mixed breed.
*
Your answer
If your dog is purebred, what kind of lineage does your dog come from?
*
Working/sporting lines
Conformation/pet lines
Both working/sporting and conformation/pet lines
Not sure
Does not apply -- my dog is not purebred
Other:
If your dog is purebred, is your dog registered with a registry? For example, the American Kennel Club. If so, please write the name of the registry/registries here. If not, write "No."
Your answer
Is your dog a village dog (from a free-ranging population of dogs)? If so, what region do they come from?
*
Your answer
Is your dog currently involved in a working or sporting activity? If so, please select the activity/activities in the checkboxes below.
My dog is involved in no work or sports
Agility
Barn Hunt
Bikejoring
Canicross
Disc Dog
Dispatching Vermin
Dock Diving
Earthdog
Fast CAT
Flushing Prey
Flyball
Guide Work
Herding
Lure Coursing
Livestock Guarding
Mushing
Nosework
Obedience
Pointing Prey
Protection/Bite Work
Rally
Retrieving Prey
Scent Detection
Search and Rescue
Service Work
Therapy Work
Tracking
Treeing Prey
Other:
Dog Weight (in lbs)
*
Your answer
Is your dog spayed/neutered?
*
Yes
No
If so, how old was your dog when he/she was spayed/neutered?
Your answer
Is your dog on any medication?
*
Yes
No
If so, please list.
Your answer
How old was your dog when you first got him/her?
*
Unkown
Other:
Were you the first owner? (After the breeder)
*
Yes
No
Unknown
How many people currently live in the same house as your dog?
*
Your answer
How many other animals currently live in the same house as your dog? What kind?
*
Your answer
Do you think your dog knows his/her own name?
*
Yes
No
Do you think your dog knows the names of other humans?
*
Yes
No
If so, how many?
Your answer
Do you think your dog knows the names of other animals?
*
Yes
No
If so, how many?
Your answer
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