FCHS Entry Assessment: Dog

Answering these questions honestly will not stop the FCHS from admitting your animal but will ensure that we are able to provide the correct care for your animal. Please help us to help your animal.

Animal Name
Species	Bird Camel Cat Chicken Chinchilla Cockatiel Dog Donkey Dove Ferret Gerbil Goat Goldfish Goose Guinea Pig Hamster Hedgehog Horse Llama Mouse Owl Pig Pony Rabbit Rat Snake Terrapin Tortoise
Breed	Abyssinian Affenpinscher Afghan Hound Airedale Terrier Akbash Akita Alaskan Malamute American Bulldog American Curl American Eskimo Dog American Shorthair American Staffordshire Terrier American Water Spaniel American Wirehair Anatolian Shepherd Appenzell Mountain Dog Applehead Siamese Australian Cattle Dog/Blue Heeler Australian Kelpie Australian Shepherd Australian Terrier Balinese Basenji Basset Hound Beagle Bearded Collie Beauceron Bedlington Terrier Belgian Shepherd Dog Sheepdog Belgian Shepherd Laekenois Belgian Shepherd Malinois Belgian Shepherd Tervuren Bengal Bernese Mountain Dog Bichon Frise Birman Black and Tan Coonhound Black Labrador Retriever Black Mouth Cur Bloodhound Bluetick Coonhound Bobtail Bombay Border Collie Border Terrier Borzoi Boston Terrier Bouvier des Flanders Boxer Boykin Spaniel Briard British Shorthair Brittany Spaniel Brussels Griffon Bullmastiff Bull Terrier Burmese Burmilla Cairn Terrier Calico Canaan Dog Canadian Hairless Cane Corso Mastiff Carolina Dog Catahoula Leopard Dog Cattle Dog Cavalier King Charles Spaniel Chartreux Chesapeake Bay Retriever Chihuahua Chinchilla Chinese Crested Dog Chinese Foo Dog Chocolate Labrador Retriever Chow Chow Clumber Spaniel Cockapoo Cocker Spaniel Collie Coonhound Corgi Cornish Rex Coton de Tulear Cymric Dachshund Dalmatian Dandi Dinmont Terrier Devon Rex Doberman Pinscher Dogo Argentino Dogue de Bordeaux Domestic Long Hair Domestic Medium Hair Domestic Short Hair Dutch Shepherd Egyptian Mau English Bulldog English Cocker Spaniel English Coonhound English Pointer English Setter English Shepherd English Springer Spaniel English Toy Spaniel Entlebucher Eskimo Dog Exotic Shorthair Extra-Toes Cat (Hemingway Polydactyl) Field Spaniel Fila Brasileiro Finnish Lapphund Finnish Spitz Flat-coated Retriever Foxhound Fox Terrier French Bulldog German Pinscher German Shepherd Dog German Shorthaired Pointer German Wirehaired Pointer Glen of Imaal Terrier Golden Retriever Gordon Setter Great Dane Greater Swiss Mountain Dog Great Pyrenees Greyhound Havana Havanese Himalayan Hound Hovawart Husky Ibizan Hound Illyrian Sheepdog Irish Setter Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Italian Spinone Jack Russell Terrier Japanese Bobtail Japanese Chin Javanese Jindo Kai Dog Karelian Bear Dog Keeshond Kerry Blue Terrier Kishu Komondor Korat Kuvasz Kyi Leo Labrador Retriever Lakeland Terrier Lancashire Heeler Leonberger Lhasa Apso Lowchen Maine Coon Maltese Manchester Terrier Manx Maremma Sheepdog Mastiff McNab Miniature Pinscher Mixed Breed Mountain Cur Mountain Dog Munchkin Munsterlander Neapolitan Mastiff Newfoundland Dog New Guinea Singing Dog Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norwegian Forest Cat Norwegian Lundehund Norwich Terrier Nova Scotia Duck-Tolling Retriever Ocicat Old English Sheepdog Oriental Long Hair Oriental Short Hair Oriental Tabby Otterhound Papillon Patterdale Terrier (Fell Terrier) Pekingese Persian Peruvian Inca Orchid Petit Basset Griffon Vendeen Pharaoh Hound Pit Bull Terrier Pixie-Bob Plott Hound Pointer Polish Lowland Sheepdog Pomeranian Poodle Portugese Podengo Portuguese Water Dog Presa Canario Pug Puli Pumi Ragamuffin Ragdoll Rat Terrier Redbone Coonhound Retriever Rhodesian Ridgeback Rottweiler Russian Blue Saint Bernard St. Bernard Saluki Samoyed Schipperke Schnauzer Scottish Deerhound Scottish Fold Scottish Terrier Scottie Sealyham Terrier Selkirk Rex Setter Shar Pei Sheep Dog Shepherd Shetland Sheepdog Sheltie Shiba Inu Shih Tzu Siamese Siberian Siberian Husky Silky Terrier Singapura Skye Terrier Sloughi Smooth Fox Terrier Snowshoe Somali South Russian Ovcharka Spaniel Sphynx (hairless cat) Spitz Staffordshire Bull Terrier Swedish Vallhund Terrier Thai Ridgeback Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Tiger Tonkinese Tosa Inu Toy Fox Terrier Treeing Walker Coonhound Turkish Angora Turkish Van Vizsla Weimaraner Welsh Corgi Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Westie Wheaten Terrier Whippet White German Shepherd Wire-haired Pointing Griffon Wirehaired Terrier Xoloitzcuintle/Mexican Hairless Yellow Labrador Retriever Yorkshire Terrier Yorkie
Sex	Male Female
Age
Brief Description
Has the animal lived with children?	NoYes
If so, please specify ages
If no, has the animal met children and what was his/her reaction?
What age groups were any children met?
Has the animal lived with dogs?	NoYes
If so, please specify age and sex
Has the animal lived with cats?	NoYes
If so, please specify age and sex
Has the animal lived with animals other than cats and dogs?	NoYes
If so, please specify the species	Bird Camel Cat Chicken Chinchilla Cockatiel Dog Donkey Dove Ferret Gerbil Goat Goldfish Goose Guinea Pig Hamster Hedgehog Horse Llama Mouse Owl Pig Pony Rabbit Rat Snake Terrapin Tortoise
Is the animal used to men and women?
What is the animal's reaction if you approach it when it is feeding?
Please describe your animal's feeding regime - brands of food, scraps, dry or tinned, flavours, feeding times and quantities. Any dislikes?
Has the animal been neutered?	Not known Yes No
What commands does your animal obey? And what commands are used? For example, sit or sit down; lie or lie down etc.
Owner's reason for parting with animal
Where did you get the animal from initially?
Is the animal upto date with its annual vaccinations?	NoYes
Date of last vaccination
Is the animal housetrained?	NoYes
Does the animal travel well in cars?	NoYes
Do you leave the animal alone for any period of time? If so, how long for and do you have concerns about them being on their own?
Has the animal ever been destructive in the house? Please describe
Where does the animal sleep?
Will the animal give up toys when commanded to?	NoYes
Would you describe your animal as a gentle player or does he/she like "rough" play? Describe your animal's play activity, eg. favourite game, favourite toy, etc.
How does your animal react to grooming?
hHow does your animal behave at the vets?
How does your animal react when he/she has done something wrong? How do you "tell him off"?
Does the animal pull on the lead?	NoYes
Does your animal return when called whilst off the lead?	NoYes
First name
Surname
Address
Postcode
Telephonenumber
Emailaddress
Person providing information	Owner Agent Inspector