| PUPPY / DOG INFORMATION |
| Breed: |
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| Age: |
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| Name: |
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| Has dog been spayed or neutered? |
Yes No |
| Is dog current on all vaccinations (Rabies, Bordetella, DHLPPC)? |
Yes No |
| Is dog heartworm negative and on heartworm preventative? |
Yes No |
| Does dog have CEE/CERF showing no eye diseases? |
Yes No |
| Does dog have x-rays showing OFA good/excellent? |
Yes No |
| Has dog had any health problems or genetic conditions, or is there a family history of either? |
Yes No |
| Does dog have any allergies or is there a family history of allergies? |
Yes No |
| Has dog been exposed to any contagious diseases such as Parvo, Giardia, Papilloma (dog warts), or Kennel Cough? |
Yes No |
| Can you provide Canine Angels with pedigree information for your dog? |
Yes No |
| Does the dog have AKC paperwork? |
Yes No |
| Does your dog go out into public with you (ex. pet stores, feed stores, parks, pet-friendly stores and places)? |
Yes No |
| Has the dog been socialized with children, other dogs and cats? |
Yes No |
| If so, what was the dog's reaction? |
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Is there anything else about the dog you would like us to know?
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