Home Ever After – Dog Assessment Form Thank you for starting the journey of safeguarding your pet’s future welfare. By enrolling your furry friend in the Home Ever Program you will ensure your pet is always looked after come what may. To complete this form you will need to have to hand the following items: Your pet’s microchip number Your vet’s contact details Your pets medication details, if applicable Your pet’s vaccination record Your breeder’s details, if applicable We anticipate the form will take 20 minutes to complete. You can save the form and come back later if necessary too. If you have any questions about the form, please contact the Home Ever After team on 02 9782 4419. 1Personal Information2Vet Details3Dog Information4Environment/Lifestyle5Play/Exercise6Family Relationships7Training8Punishment9Handling10Aggression11Additional Problems12Can we? Personal InformationName* First Last Email* Address Address line 1 Address line 2 Town/suburb State Postcode Phone: HomePhone: Mobile*Preferred method of contact Mobile Home Best time to contact Morning Afternoon Evening Second owner's details if any First Last Email PhoneYour HEA Agreement form must be witnessed, please provide their details: First Last Email Address Address line 1 Address line 2 Town/suburb State Postcode Vet DetailsClinic* Name Vet First Last Address* Address line 1 Address line 2 Town/suburb State Postcode Phone Dog InformationName First Date of birth MM slash DD slash YYYY BreedWeightSexMaleFemaleColourDistinguishing FeaturesDesexed?YesNoMicrochip Number (15 digit unique number)Medications? Please SpecifyVaccinations Due/WhenRegistered with council?YesNoWhere did you obtain this dog?Breeder (if applicable)Behaviour of parents or litter mates (if applicable) Environment/LifestyleFor what purpose did you get your dog? Companion Show Breeding Working Age of dog when obtainedFeedingAmount Fed (grams)Type of foodFrequency of feedingWho does the feeding?When fed and where?Favourite treatSupplements given Play/ExerciseFavourite gameType of exerciseAmount/Frequency of exerciseAmount/Frequency of playFavourite Toy(s)Describe where your dog stays at each of the following times:Daytime (owner away)Daytime (owner home)Night timeWhen guests visitHow long is your dog alone each day?Reaction prior to departureReaction to homecomingLeft alone outdoors?How often/long?Where is your dog when outside?Type of dwellingHow does your dog react to car rides? Family RelationshipsList family members (include sex and age) who have a relationship with the dog:Which family members have the best control?Which family members have the least control?List all other pets including breed, age and sex:Describe how your pets get along with each member of the family and each pet:Briefly describe your dog’s personality: TrainingHas your dog had obedience training? Y/N. Where?Was it successful?What can your dog do on command?Crate TrainingHas your dog been crate trained?Do you still use the crate?Crate typeLocation DisciplineDo you use discipline with your dog?If yes, describe:PhysicalNoiseWater SprayerVerbalHas any discipline made the problem worse? Yes No If yes, describe: HandlingHow does your dog react to the following? Nail TrimmingCleaning EarsGiving MedicationGrooming/BathingPettingRubbing BellyStrangers visiting homeBeing liftedRolling overGrasping collarFamiliar dogs on propertyFamiliar dogs off propertyNew dogs on propertyNew dogs off propertyStrangers on propertyStrangers off propertyStrangers arriving indoorsOther animals AggressionIs your dog aggressive toward family members? Yes No If yes, how?Is your dog aggressive to other people? Yes No If yes, how?Has your dog ever bitten hard enough to break the skin or cause injury? Yes No If yes, how?Under what circumstance did this occur?How long ago?Was there an illness or health problem when the aggression started?When your dog is aggressive what is your response?Anything else you would like to share?Phobias/characteristics Additional problemsDestructive digging Yes No Barking Yes No Whining Yes No House soiling Yes No Chasing Yes No Jumping up (guests/owners) Yes No In rooms where not permitted Yes No Food stealing Yes No No recall (won’t come when called) Yes No Urine marking Yes No Tail biting Yes No Uncontrollable urination (excited) Yes No Uncontrollable urination (frightened) Yes No Destructive chewing Yes No Howling Yes No Stool eating Yes No On furniture where not permitted Yes No Garbage raiding Yes No Demanding (wants own way) Yes No Mounting Yes No Chews/Licks itself Yes No Fly chasing Yes No Can we….Re-home with children?Re-home with male/female?Re-home with another dog?Re-home with a cat?Needs a quiet home?Please attach a photo of your dogMax. file size: 128 MB.Consent By clicking on the submit button, you declare that you are the legal guardian of the pet and the information you have provided is accurate and true as of today’s date.
