Online Guide Dog Team Eval

First Name:
Last Name:
Email Address:
Home Telephone Number:
Dog's Name:
Tatoo #:
Dates of Class:
How was your trip home? Did you encounter any difficulties?
Has your guide dog become accustomed to his/her new surroundings at home?	yes no
Has your guide dog become accustomed to his/her surroundings at your place of employment?	yes no
Have you been able to get the recommended dog food?	yes no
If not, what are you feeding him/her?
Is he/she eating properly?	yes no
Is he/she gaining weight?	yes no
Does he/she relieve itself properly?	yes no
Are his/her habits clean in and around your home?	yes no
Is he/she worked daily?	yes no
Approximately how many hours a day?
Approximate the number of blocks or distance traveled daily.
Primarily you travel by (you may select more than one)	Bus Train Car Subway
Do you have any difficulties when crossing streets?
What is his/her reactions in crowded places, such as stores, etc...?
Has he/she become over-protective?	yes no
Do you give him/her extra obedience work?	yes no
Are you experiencing any difficulties with your dog?	yes no
If so, please state the problems:
Additional Comments or thoughts about your guide dog experience:

Name of Veterinarian:
Name of Clinic:
Vet Telephone Number:
Address of Clinic: