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Dog Evaluation Forms EVALUATION OF OWNER SURRENDER DOGS Evaluation done by: Your Email: Phone number that is best to reach you if we have questions: Date of Evaluation: To which state is this form going? OWNER INFO Owner's Name: Owner and Dog's Location: (City, State) BASIC DOG INFO Dog's Name: Dog's Age: (Birthdate if known) Color: Liver/White Black/White Tri-Color Type: Bench Field Not Sure Possibly a Mix Tail Docked: Yes No Spayed/Neutered: Yes No Unknown Where did the owner get the dog? If breeder, what name and town? Was he/she from a shelter? Another person? Try to get as much background as possible. 1

What did the owner say about the reason for relinquishment? Where does the dog currently stay and sleep? Inside? Outside? If inside, does he/she have full range of the home or just part? Describe the dog's home and living conditions. KNOWN BEHAVIORS AND CONDITIONS How active is the dog (per owner) and what type of activity or exercise does he/she get? (Your observations will be later in the form) Does he/she ride well in the car? Yes No Unknown Is he/she good with grooming? Yes No Unknown Is he/she good at the vet? Yes No Unknown Is the dog house-trained? Yes No Partially Unknown Is the dog crate trained? Yes No In the past, not now Has problems with crating How does the dog behave on a leash? Does he/she have any separation anxiety? (Problems when you leave him/her alone.) Yes No Other Does the dog have any behaviors that you wish he/she didn't have (such as jumping, digging, chewing, fear of thunderstorms)? How does the dog behave with other dogs? 2

Any dominance or submissive behavior with other dogs or with people? How does the dog behave with cats? What commands does the dog know? Did he he/she ever go to an obedience class or was it learned at home? Has he/she ever shown any growling or guarding or aggression towards people? Has he/she ever bitten anyone? BEHAVIOR OBSERVATIONS Check those applicable and comment further below. How did the dog behave when you first arrived? Friendly Curious On-guard/barked but quickly relaxed Cautious Fearful Assertively barked and challenged. How did the dog behave after about 10 minutes? Friendly Relaxed Still on-guard/barking Nervous Fearful. Is he trying to bond or seek attention? Call the dog over if needed. Will he/she come to you for attention? Any other behavior comments? 3

BASIC PHYSICAL EVALUATION Check those applicable and comment further below. BEFORE HANDLING THE DOG, ask about any current or recurrent health conditions, such as ear infections, skin problems, or medications used (other than preventative.) Describe any conditions. i.e. if there are recurrent ear infections, you may need to be more cautious about touching his/her ears or avoid any sore spots on the body. Once the dog is relaxed and you feel comfortable, try to touch or pet the dog. If he/she remains relaxed and non-stressed, gradually touch all over, ears, muzzle, underside/belly, back, and feet. How does he/she react? Calm/relaxed, Excitable or barely stays still Loves the attention Submissive Tolerant but not pleased Too tense or stressed to proceed to touching. Eyes: They both appear normal Red Drainage Cloudy Ears: They both appear normal, reasonably clean and non-odorous Drainage and/or redness in one or both ears Odor from one or both ears Tender to touch in one or both ears Dog wouldn't permit evaluation Didn't get a chance to check Teeth: 4

They appear normal, reasonable small amount tartar for age Some broken teeth Heavy tartar build-up Poor condition Dog wouldn't permit evaluation Didn't get a chance to check Coat and Skin: Normal coat No rashes or bald spots or hot spots or wounds Matted/poor coat Bald spots or hot spots or rash Flaky/dry skin Didn't get a chance to check all over Body condition/weight: Just right or close. Able to feel some ribs fairly easily. Overweight Underweight or malnourished Skinny but looks healthy Any comments about the dog's physical condition? SUMMARY Are there any personality quirks that make you uncomfortable or any signs of aggression? Any comments or ideas about a good foster home or adoptive home situation? 5

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