BEHAVIORAL SCREENING (
to be completed by your veterinarian)
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| VETERINARIAN:_______________________________ | VACCINATION DATES |
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| CLINIC:______________________________________ | ||
| OWNER:_____________________________________ | RABIES: 1yr 3yr________________________ | |
| ADDRESS:____________________________________ | DHLPPV:_______________________ | |
| CITY: _______________ST: _______ZIP: ___________ | CORONA:_______________________ | |
| PHONE:_____________________________________ | BORDETELLA:___________________ | |
| PET'S NAME:_________________________________ | FECAL: + / - _____________________ | |
| BREED / COLOR:______________________________ | HIPS: excellent good other | |
| GENDER: male female neutered spayed | EYES: excellent good other | |
| DOB: _______________________________________ | ||
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| DOES THE ANIMAL HAVE AGGRESSIVE TENDENCIES TOWARDS PEOPLE? | Y |
N |
| OTHER ANIMALS? | Y |
N |
| HAS THE ANIMAL EVER BITTEN ANYONE? | Y |
N |
| DOES THE ANIMAL HAVE FOOD AGGRESSION? | Y |
N |
| IS THE ANIMAL DOMINANT IN NATURE? | Y |
N |
| DOES THE ANIMAL SEEM SOCIABLE? | Y |
N |
| DOES THE ANIMAL HAVE POSSESSIVE TENDENCIES? | Y |
N |
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| FROM YOUR PROFESSIONAL STANDPOINT AND OBSERVATION OF THIS ANIMAL, DO YOU HAVE ANY HESITATIONS RECOMMENDING THIS ANIMAL FOR MUTTESSORI? | ||
| _____________________________________________________________________________________ | ||
| _____________________________________________________________________________________ | ||
| _____________________________________________________________________________________ | ||
| ___________________________________ | ||
| VETERINARIAN 'S SIGNATURE | ||