Dog Profile Questionnaire Template Page 3
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429. Has your dog escaped your property 2 or more times in the last 6 months?
No
Yes
________________________________________________
(please describe)
Yes
No
Not Sure
Tried, but didn’t make contact
30. Has your dog ever bit a person?
Date of last bite: __________
Please describe the incident(s) in detail: _________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Yes
No
Not Sure
31. Has your dog ever attacked another dog resulting in severe injury or death to another dog?
32. Has your dog ever attacked another domesticated animal species?
No
Not Sure
Yes
__________________
(what)
33. Please check the appropriate box if your dog has ever shown any of the behaviors listed toward the following (do not include
behaviors directed toward a groomer or veterinarian):
Shows teeth/growls
Snaps
Bites
None of these
Do not know
Men
Women
Children
Dogs
Cats
Other domesticated
animals
34. If you checked any of the behaviors above for men, women or children, please answer the following questions:
Men
Women
Children
Yes
No
Yes
No
Yes
No
Was the behavior over food?
Was the behavior over rawhides or bones?
Was the behavior over toys?
Was the behavior over stolen objects?
Was it when the dog was disturbed while sleeping or resting?
Was it when an adult or child handled the dog?
Was it when an adult or child entered the house or yard?
Was it when an adult or child approached or reached toward the dog?
35. If a snap or bite to men or women was checked, did the snap or bite to an adult take place while breaking up a dog fight or
while a dog was in severe pain?
Yes
No
36. If a snap or bite to children was checked, did the snap or bite to the child take place while breaking up a dog fight or while a
dog was in severe pain?
Yes
No
37. When was this dog last seen by a veterinarian? ________________
Veterinarian’s Name/Phone _________________________________
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