CALL US:

804-795-9415

2610 Shadewood Lane

Charles City, VA 23030

New Pet Questionnaire
with Group Play

A Stay in the Country Pet Lodge and Training Center

Please complete this questionnaire fully — one form per dog.

    Owner Information

    Dog Information

    (One form per dog)


    BreederShelter/RescueFriend/FamilyFound StrayOther


    (Check all that apply)

    DAYCAREBOARDINGGROOMING

    Daycare & Social History

    (Check all that apply)

    Socialization with dogsExerciseNot home alone / separation anxietyRecommended by trainer/vetOther



    NoneLimited (mostly on-leash)Some off-leash playRegular off-leash play/daycare/parks

    (Check all that apply)

    NoYesFight or altercation with a dogFearful or overwhelmed in groupsDismissed from daycare or group playOther



    Health & Physical Considerations


    YesNo


    NoYes

    BEHAVIOR & HANDLING

    How does your dog typically react to:


    FriendlyNeutralNervousReactive


    GoodTolerantAvoidsNot good


    FriendlyReservedNervousProtective


    ComfortableTolerantNervousNot good


    Growled, snapped, or bitten a personGrowled, snapped, or bitten another dog or animal


    NoYes

    Play Style & Energy


    YesSometimesNo

    (Check all that apply)

    ChaseWrestlingRoughGentleSelective


    Small dogsLarge dogsAll sizesMalesFemales


    LowMediumHigh

    Training & Management


    SitDownStayComeLeave ItOther


    VeryModerateInconsistent


    Flat collarHarnessHead collarProngOther

    SAFETY & CONTAINMENT


    NoYes


    NoYes

    STRESS & SENSITIVITIES


    NoYes


    NoYes

    FINAL NOTES