Therapy Dog Evaluation Independent Therapy Dogs, Inc.
NOTE: Dog must test on flat buckle collar and 4 foot leash. Training collars/devices are not allowed for evaluations.
Owner/Handler Name__________________________________________________________________________________ Phone(s) ___________________________________________________
Address, City, State, Zip ________________________________________________________________________________ Eddress ____________________________________________________
Dog’s Name ________________________________________ Breed __________________________________________ Dog’s Age ___________________________________________________
Why do you want to do therapy dog visiting? _______________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________
Have you ever done therapy dog visiting? _____________________________________________ Therapy Program (name) _________________________________________________
Canine Good Citizen Certification date _________________________________________ Proof provided ___________________________________________________________
P- F Evaluation Criteria Comments
Accept a friendly stranger: Demonstrates dog will allow friendly stranger to approach it; speak in a natural everyday
situation. Dog shows no sign of resentment or shyness; must not break position or try to go to handler on approach. __________________________________
Sit politely for petting: Dog allows friendly stranger to touch it while w/ handler. Dog shows no shyness or resentment
when petted on its head and body. __________________________________
Allows evaluator to stroke the head and body tail with both hands. __________________________________
Allows evaluator to apply the following actions:
Pull ears and put fingers in ears Touch and press paws/nails, press body Scratch/pet dog’s throat
Check teeth for cleanliness Pull tail __________________________________
Allows evaluator to hug around dog’s neck and body? 1 person Group of people __________________________________
Does the evaluator observe any of the following: Excessive sniffing Barking Excessive licking __________________________________
Walk on loose lead: Dog leaves no doubt that it is attentive to the handler and is responding to the handler’s
movements and change of direction. Demonstrates handler is in control of the dog. __________________________________
Walking the Crowd: Dog moves politely through pedestrian traffic; is under control in public. Dog continues to walk past several
people with little interest; without over-exuberance, shyness, resentment. Dog does not jump on people; strain the leash. _________________________________
Dog allows multiple people at once to crowd and pet. __________________________________
Dog does not attempt to jump on people. __________________________________
Dog does not overreact to being bumped from behind:
Sit and down on command: Dog must sit AND down on command. With long leash dog must stay and remain until
evaluator instructs the handler to release the dog. __________________________________
Recall/coming when called: Dog comes immediately when called. __________________________________
Reaction to another dog: Dog behaves politely around other dogs. Two handlers and their dogs approach dog and dog
should show no more than casual interest in other dog. Neither dog should go to the other dog or its handler. __________________________________
Reaction to distraction: Dog remains confident when faced with common distracting situations. Evaluator presents two. Dog may
express natural interest or may appear slightly startled but should not panic, try to run away, show aggressiveness, or bark. _______________________________
Does evaluator observe fear or excessive reaction to the following:
Doorways enter/exit Sudden loud noise/overhead pager/Cell phone/alarm Wheelchair/walker/cane/crutches Stairs up/down Elevator
Children Surface textures: grass, cement, wood __________________________________
“LEAVE IT” Dog follows command to “Leave it”? (food and toy) __________________________________
Overall Evaluation and Conclusion
Dog demonstrates willingness to participate in evaluation: ______________________________________________________________________________________________________
Dog demonstrates ability to calm down and respond if excited: _________________________________________________________________________________________________
Did dog become unresponsive to commands during evaluation: _________________________________________________________________________________________________
Did dog make any attempt to mark territory: ______________________________________________________________________________________________________________________
Was handler in control of dog at all times: __________________________________________________________________________________________________________________________
Was handler clean and dressed appropriately: _____________________________________________________________________________________________________________________
Did handler offer praise to dog when appropriate: ________________________________________________________________________________________________________________
Was owner friendly with a positive attitude: ______________________________________________________________________________________________________________________
Is Team ready for therapy dog visiting? PSV (Pass w/supervised visits) PASS FAIL
OVERALL OBSERVATIONS/COMMENTS
________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________ DATE: _________________________________________________
SIGNATURE Evaluator
_____________________________________________________________________________________________________________ Eddress: ______________ ________________________________
PRINT Evaluator’s Name