Placement Pyr Evaluation Form

(Telephone contact) Date:____________ Internal ID #___________________

Name: _______

Address: ____ __ ______

Phone #: Email___ ______

Name: Age: ____________________ Sex: _____________

Markings_________________________________ Spayed/Neutered?: __________________ Current on vaccinations?_____________ Heartworm preventative? Brand?__________________

Breeder: ___________Has Breeder been contacted?

If no, why not? _____________

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1. Why is placement necessary?

2. Is the dog housebroken?

3. Describe behavior: Bark Y/N Chew Y/N Dig Y/N

Reaction to other dogs?___________________ unfamiliar adults?________________

4. Has he/she ever bitten anyone?

5. Any health problems?

6. Has the dog been raised with children?

7. What type of training has the dog received? Crate trained?_____________________

Obedience trained?_______________________________ Good on leash: Y/N

8. How is the dog maintained while owners at home?_____________________________

When owners are not home?______________________________________________

9. Type of fencing?_______________________________________________________