Reactive Dog Questionnaire

Reactive Dog Questionnaire
About You
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number (cell)

Area CodePhone Number
E-mail
Dog Information
Dog Name
Breed
Gender
Birth Date

MonthDayYear
Veterinarian
Who may we thank for referring you?
CURRENT PROBLEM: What does the dog do? What triggers this behavior? How long has it been occurring?
LIFESTYLE: Inside or outside? How long is dog alone? Where does dog sleep?
FOOD: What kind, how much and how often?
EXERCISE: What kind, how much and how often?
HEALTH: Current and past health problems (allergies, ear infections, injuries, arthritis, etc.)
MEDICATION: List all medications your dog is on.
TRAINING: What training has your dog had in the past? What training has been attempted to correct this behavior problem?
BITE HISTORY: Has dog ever bitten another dog or human? Did is result in an injury (bleeding, stitches, etc.)?
GOAL: What do you hope to accomplish with this training?
Should be Empty:

About You