EmailMe Form - GLENBERN GOLDENS QUESTIONNAIRE

First and Last Name of Primary Caregiver:

First and Last name of Secondary caregiver:

Email

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Numbers?

What is your dog's name?

What is your dogs birthdate?

Is your dog male or female? Are they spayed or neutered?

Is your dog still alive. If passed away, at what age and what from?

Please continue with the questionnaire.

Has your dog had any ongoing health issues? Like food allergies (Brands) or environmental issues, GI issues, etc. At what age? Were you able to manage it or fix it and how?

Has your dog had any major health issues? At what age? Please explain

Did you continue with pet insurance? Which company? Were you satisfied with this company?

What do you vaccinate for? DHAPP (Distemper, Hepatitis, Adenovirus Parvovirus, Parainfluenza), Lyme, Leptospirosis, Rabies?

Has your dog had any bad reactions to any of these vaccines?

Is your dog up to date on vaccinations? Do you vaccinate with all vaccines in one vet. visit or do you spread them out over a couple of weeks?

Have you ever done titer testing for Parvovirus & Distemper to see if your dog still has immunity to these diseases?

Do you use any Flea & Tick preventatives? Which ones (Oral type) Nexguard, Bravecto, Simparico, other? (Spot on type) K9 Advantix, Bravecto, other?

Has your dog had any bad reactions to any?

Do you feed raw, homemade or kibble? What type and brands of food have you fed?

Is your dog overweight? If so by how much?

How much ON leash exercise does your dog get in a day? Approximate time, like 3 - 15 min. walks, etc.

How much OFF leash running time does your dog get in a day i.e., off leash dog parks, hiking trails, playing fetch in a big wide-open field, etc.

Have you had any temperament issues with your dog? Fearfulness, dominance, resource guarding (food, toys, bed, people?) biting, anxiousness, excessive barking, noise sensitivity, etc. Please explain. How did you fix it or manage it?

Have you taken your dog for any classes? Like obedience, fly ball, dock diving, agility, field work, scenting, etc.?

Does your dog get along with other dogs, cats and people?

Do you have any children or grandchildren that visit regularly? Does your dog do well with children?

Any information you would like to include please do.