Behavioral Questionnaire
Please be as thorough as possible! The more information you provide, the better I can help you. If you do not yet have your dog, please write "N/A" for any information you do not know.
Name
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First Name
Last Name
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
How did you hear about us? (Please be specific so we can send a thank you!)
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What is your Dog's Name?
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Dog's Date of Birth (approximate if you don't know)
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Dog's Breed(s):
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Male/Female, Neutered/Spayed:
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Dog's Veterinarian:
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Where did you get your dog?
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How old was your dog when you got him/her?
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What is the name of your dog's flea/tick and heartworm prevention?
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Please list any known medical conditions and/or medications/supplements, or any medical concerns:
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Does your pet have any food or environmental allergies or sensitivities? Please elaborate.
I understand and agree that I am required to submit proof of up-to-date vaccinations (Rabies and DHPP vaccine, Bordetella if boarding) prior to beginning training.
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Yes
No
What food brand/protein does your dog eat?
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How much food and how often?
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Is this your first dog?
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Yes
No
If you answered no, please elaborate:
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Please list each family member in the home and their ages:
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Please list all other animals in the home, their species and age:
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Behavioral Concerns (please check all that apply):
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Puppy Nipping/Mouthing
Biting (no blood drawn or medical attention needed)
Biting (medical attention required)
Jumping on people
Pulling on the leash
Begging for table food
Excessive barking in the home
Excessive barking/nonsense in the crate
Destructive (chews/eats your personal items or property)
Reactive to other dogs (barking, lunging, etc)
Reactive to people inside the home/property
Reactive to people outside the home/property
Muzzle needed at groomer or vet
Growls over food or toys with humans
Growls over food or toys with other dogs
Growls over space (kitchen, couch, bed, etc)
Growls over you or another member of the home
Fights with other animals in or out of the home
Eats feces
Eats grass
Marks or pottys inside the house
Shows anxiety or fear
Scared of loud noises
Doesn't come when called
Doesn't listen to cues at all (sit, down, heel)
Doesn't listen to cues when distracted
Paw licking
Light chasing
Spinning/circling
Nail chewing
Masturbation
Car sickness
Fly chasing
Tail chasing
Bed wetting (while sleeping)
Overactive
Excitability
Digging
Garbage raiding
Pushy/Wants own way
Barking/Howling
For each box you checked above, elaborate:
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What have you tried that made the problem worse?
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What have you tried that made the problem better?
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What do you think is the reason for this issue?
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What is your reaction when your dog does the undesirable/problem behavior?
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Any additional comments on issues you are facing with your dog:
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What are your goals for your dog? (Dream big here!)
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Do you want to eventually be able to trust your dog off-leash?
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Is your dog reliably crate trained?
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Yes
No
Is your dog reliably potty trained?
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Yes
No
What cues do you feel your dog already reliably knows/performs?
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Sit
Down
Heel
Come when called
No
Place
Kennel/Crate
Release word
Leave it
Drop it
Tricks (shake, touch, etc)
Other
Which commands are most successful?
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Which commands are least successful?
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How does your dog react to nail trimming?
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How does your dog react to grooming?
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How does your dog react to having their collar grabbed?
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How does your dog react to having their back pet?
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How does your dog react to having their belly pet?
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What types of punishment have you already tried?
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Physical punishment (hitting)
Noise punishment (shaker can, clapping)
Ultrasonics
Water sprayer
Verbal
Physical handling
Muzzle grasp
Roll over
Pinning
Time out
Other
What types of punishment are most successful?
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What types of punishment are least successful?
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Does your dog react aggressively to any types of punishment?
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Which family member is most successful with punishment?
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Which family member is least successful with punishment?
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Does your dog live primarily inside or outside?
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Inside
Outside
How much time do you realistically have to dedicate to training your dog on a daily basis? (There is NO wrong answer! This will help North Star Canine decide which training program will fit you best)
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Under 10 minutes or no time at all
20-30 minutes
30-60 minutes
More than one hour
How much time does your dog spend actively exercising each day? (Being free in the back yard does does not apply)
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Describe what kind of exercise- frequency, amount of time, kind of exercise, etc):
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How long and how often is your dog left home alone each day?
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Where does your dog stay when left home alone?
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What is your dog's reaction prior to your departure?
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What is your dog's reaction when you come home?
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Do you understand and agree that training a dog requires practice and consistency from all members of the household?
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Yes
No
Do you understand and agree that every dog is different and no training result is ever guaranteed?
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Yes
No
Do you understand and agree that you will not be refunded for any program or equipment at any time, and if you opt for a payment plan and decide to not finish a program, you will still be required to pay the remaining balance within 30 days?
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Yes
No
Do you understand and agree that if you cancel a lesson without 12 hours notice, that lesson will be forfeited and deducted from your program plan, and you may be subjected to a no show fee?
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Yes
No
Do you understand and agree that if you are late to a lesson, we will still end the lesson at the appointed time?
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Yes
No
I understand and agree that I am obligated to tell North Star Canine LLC if my dog has any history of biting or aggression (please sign):
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The information provided in this questionnaire is true.
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Date
*
-
Month
-
Day
Year
Date
Submit
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