Weeks:
Months:
Male
Female
Male/Neutered
Female/Spayed
yes
no
1.
2.
3.
I'm a current client
My Veterinarian
Someone referred me
Pet Store
Groomer
Facebook
Telephone Book
Breeder
Webpage
Newspaper
Other
Yes
No
Barking
Jumps up on people
Eliminates indoors
Pulls on leash
Aggressive to humans
Aggressive to cats
Shy/Nervous/Fearful
Destructive Chewing
Does not listen to me
Growls if I try to take a chew/toy away
Aggressive to dogs
Adults
Children
Another Pet/Animal
Blair Animal Clinic
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