In-Depth Evaluation

Coordinator *

Date of Evaluation * +

Dane Name *

General Dane Information

Where does Dane come from? * 🛈

Owner

Shelter

Other Other

Sex? *

Male

Female

Pure bred? *

No

Yes

Unknown

If mix, with what?

Spayed or neutered? *

No

Yes

Unknown

Age? * 🛈

Weight? * 🛈

Height? * 🛈

Ears? *

Cropped and standing

Cropped and flopped

Natural

Color? * 🛈

Does the Dane have AKC or other papers? *

No

Yes

Not at this time

Temperament

Has the Dane lived with other dogs? *

No

Yes

Unknown

If Yes, please list the other dogs breed, sex, and if they are spayed / neutered:

Does the Dane respond well to same sex dogs? *

No

Yes

Unknown

Does the Dane respond well to opposite sex dogs? *

No

Yes

Unknown

Does the Dane meet small dogs well? *

No

Yes

Unknown

Does the Dane meet large dogs well? *

No

Yes

Unknown

Has the Dane ever been in a dog fight? *

No

Yes

Unknown

If so, what was the cause?

Has the Dane been around other dogs socially? *

No

Yes

Unknown

Has the Dane lived with cats? *

No

Yes

Unknown

If the Dane is good with cats, but has not lived with cats, please describe how the dog has been tested with cats:

Does the Dane chase cats? How does it interact with cats? *

Has the Dane been exposed to other animals (birds, ferrets, etc.)? *

No

Yes

Unknown

If yes, how has the Dane reacted?

Is the Dane good with children? *

If yes, what were their ages / sex?

Is the Dane good with men? *

Does the Dane allow a physical exam? *

No

Yes

List areas Dane is shy about (e.g. mouth, paws, ears, belly, etc.):

Does the Dane guard any high-value items (food, bedding, etc)? *

No

Yes

Only from other dogs

Unknown

If yes, what are the items?

Is the Dane OK when left alone for more than 6 hours? *

No

Yes

Only if around other dogs

Unknown

Where is the Dane kept when owners are not home? *

How many hours a day is the Dane typically left home alone?

Does the Dane have any behavioral problems - either admitted to or evidenced during the visit? *

Does the Dane appear to be well adjusted and loved, or neglected? *

How does the Dane greet strangers at the door?

Please explain, if needed:

Other tests conducted (e.g. loud noises, leash walking, sudden movements, etc.):

Explain any answers in detail for this section, if needed:

Living Environment

Is the Dane house trained? *

No

Yes

Unknown

Is the Dane crate trained? *

No

Yes

Unknown

Does the Dane travel well? *

No

Yes

Unknown

Does the Dane get regular exercise? *

No

Yes

Unknown

If yes, where and in what form?

Medical Information

How healthy does the Dane appear at first glance (i.e. too thin, too fat, shedding excessively, bald patches, etc)? *

Is the Dane tattooed or microchipped? *

No

Yes

Unknown

Is the Dane currently on any medications?? *

No

Yes

Heartworm only

If so, list medication, dosage, dosage schedule, for how long it must be taken, and for what condition it is being given:

Has the Dane had any surgeries and/or medical conditions? *

No

Yes

Unknown

If yes, for what and when?

Is the Dane current on all vaccines? *

No

Yes

Unknown

If not, which are not current?

Can the dog see? *

No

Yes

Partial

Unknown

Can the dog Hear? *

No

Yes

Partial

Unknown

Feeding

What brand food is the Dane currently eating?

How much is the Dane eating per day?

How often is the Dane fed and how much per feeding?

What treats is the Dane given?

Is the Dane fed off of an elevated platform?

No

Yes

Unknown

Obedience Training

Does the Dane have any obedience training?

No	Yes	Think So
Unknown

Does the Dane have any obedience titles?

No

Yes

Unknown

If so, please list (including CGC):

Commands demonstrated (check all that apply):

Does the Dane respond well to commands?

No

Yes

Sometimes

Unknown

Owner Information (Skip if Shelter Dog)

Owner Name:

Address:

Phone Number:

Email Address:

Is current owner the Dane's first owner?

No

Yes

Unknown

Why is current owner giving up the Dane?

Where did owner get Dane from?

If breeder, has owner attempted to contact?

No

Yes

If possible, provide name of place, person and contact info:

Is the owner willing to part with crates, dishes, toys, etc. that "belong" to the Dane?

No

Yes

Shelter Information (Skip if Owner Turn In)

Shelter Name:

Dog ID# for shelter:

Contact Name:

Phone Number:

Email Address:

Address:

Evaluator Info

Name of Evaluator *

Place where evaluation occurred * 🛈

Overall impression of Dane: *

This Dane would do best in a home that is (check all that apply): *

Black	Harlequin	Fawn
Brindle	Blue	Merle
White	Mantle	Other Other

Happy to see them	Nervous and unsure, barks and backs away
Initially barky but soon happy	Will not allow them in the house
Unknown

Sit	Down	Stay	Recall
Stand for Exam	Shake/Paw	Off/Down	Other Other

Too many dogs, this one must go	Death of owner/caretaker
Divorce	Got too big
Can't find apartment to rent that allows Danes	Too destructive
Chewing	Fighting with other dogs
Growling at family member	Bit family member
Bit stranger	Aggressive/dominant
Can't handle him/her	Economy/Can't afford
Other Other

Breeder	Rescue group
Pet store	Shelter
Other Other

Owner's home	Shelter
Neutral with owner present	Neutral with owner absent
Foster home	Other Other

Quiet with little activity	Active home with medium activity
Active home with high activity	With another dog
With kids	Without kids
Home that will work on issues	Has excellent vet care close by
Other Other