Owner Information
Name
Address
City/State/Zip
Home Phone
Cell Phone
Email Address
Your Boxer's Identifying Information
Name
Tattooed or Microchipped
Please Select
Yes
No
Tattoo or Microchip Number
Date of Birth / Age
Gender
Please Select
Male
Female
Color
Please Select
Fawn
Brindle
White
Reverse Brindle
Other
Ears
Please Select
Cropped
Natural
Tail
Please Select
Docked
Natural
Your Boxer's Medical Information
Spayed or Neutered?
Please Select
Yes
No
Date of Spay or Neuter
Date of Last Heartworm Test
Results
Please Select
Positive
Negative
Brand of Heartworm Preventative
Date of Last Dose
Brand of Flea and Tick Preventative
Date of Last Dose
Date of Last Rabies Vaccination
Vacination Type
Please Select
1 Year Vaccine
3 Year Vaccine
Date of Last DHLPP Vaccination
Date of Last Bordetella Vaccination
Date of Last Lyme Vaccination
Any Other Vaccines Given?
Date of Fecal Exam
Results
Please Select
Positive
Negative
Please list your Boxer’s major medical conditions and/or surgeries
Please list any other medications that your Boxer is currently taking
Does your Boxer have any allergies? If so, please explain
Your Boxer's Veterinarian Information
Name
Address
City/State/Zip
Office Phone
Office Fax
Email Address
Other Information About Your Boxer
Where did you acquire your Boxer?
How long have you owned your Boxer?
Why do you need to re-home your Boxer?
What type of home do you feel would best suit your Boxer?
Is your Boxer housebroken?
Please Select
Yes
No
Is your Boxer crate trained?
Please Select
Yes
No
Has your Boxer lived with children?
Please Select
Yes
No
Age(s)
Is your Boxer good with small children?
Please Select
Yes
No
Has your Boxer lived with other dogs?
Please Select
Yes
No
Is your Boxer good with other dogs?
Please Select
Yes
No
Has your Boxer lived with cats?
Please Select
Yes
No
Is your Boxer good with cats?
Please Select
Yes
No
Does your Boxer like to ride in a car?
Please Select
Yes
No
Can your Boxer jump fences?
Please Select
Yes
No
Is your Boxer a digger?
Please Select
Yes
No
Can you disturb your Boxer when eating?
Please Select
Yes
No
Can you disturb your Boxer when sleeping?
Please Select
Yes
No
Can you take a toy or bone away from your Boxer?
Please Select
Yes
No
Does your Boxer guard any persons or objects?
Please Select
Yes
No
Please describe your Boxer's personality and temperament
Please list the activities that your Boxer dislikes
Has your Boxer had any formal obedience training? If so, please provide details
Has your Boxer been protection trained? If so, please provide details
Please list the commands that your Boxer knows and responds to
What brand/type of dog food does your Boxer eat?
How much do you feed your Boxer at each meal? How many times a day?
What kind of treats does your Boxer like?
Where does your Boxer stay when alone?
Where does your Boxer sleep?
Is your Boxer shy or afraid of anything? If so, please provide details
Does your Boxer have separation anxiety? If so, please provide details
Does your Boxer have any behavior issues? If so, please provide details
Is your Boxer destructive? Is so, please provide details
Is your Boxer aggressive? If so, please provide details
Has your Boxer ever fought with another dog or animal? If so, please provide details
Has your Boxer ever bitten, nipped or snapped at a person or other dog? If so, please provide details
Please provide any other information that you think we should know about your Boxer
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