Behavior Questionnaire
Please fill out as much as possible below.
Your Name
First Name
Last Name
Pet's Name
Gender/Neuter Status
Please Select
Male
Female
Neuter Male
Spayed Female
Age When neutered/spayed?
Does your dog travel?
Please Select
Yes
No
Current Flea and Tick Prevention?
Current Heartworm Prevention?
Is your dog on any current medications for any medical problems?
What kind of food do you feed your dog, and how frequently?
Please list all other animals (name & species) living in the home.
Please list all of the other household member and relations in the home.
What age did you acquire you dog?
Where did you get your dog? (Breeder/Shelter/Friend)
How many pervious owner has your dog had?
Do your know how many puppies where in the litter? If so how many?
did you met your dogs parents?
Please Select
Yes
No
Are any litter mates affected with any medical problems?
Why did you choose this specific dog?
Activity Information
what kind of exercise does your dog get?
How many training session do you do per day?
How many walks and how long does your dog get per day?
How may play sessions and how long per day?
What does your dog do in between these actives?
How is your dog kept when you leave him/her alone?
How many hours during the day does your dog spend alone?
How many hours per day is your dog left in a crate?
Where does your dog sleep?
Training History
What kind of training have you done with your dog in the past?
Does your dog do any sport training?
Would your dog reliably do the following?
At home?
One a walk?
In a new place?
Sit
Down
Nose Target
Loose Lead Walking
Toy play as reward
Taking Food as Reward
What tricks or cued behaviors does your dog know?
Separation Information
What do you do in preparation to leave the house?
Does your dog do any of the following when left alone?
Destructive Behavior
Toileting
Vocalising
Salivating
Pacing
Panting
Eating
Drinking
Salivate
Hide or try to escape
Freeze
Panting
Pace
Refuse food or treat
Bark/Growl
Lunge
Yawn
Chase
Tremble/Shake
Seek out people
Other
Noise Response Information
Does your dog react in any way to
Thunder
Fireworks
Gunshots
Vehicles
Other domestic noises (e.g. washing machine, dishwasher, etc.)
Does your dog do any of the following behaviors with noise?
Destructive Behavior
Toileting
Vocalising
Salivating
Pacing
Panting
Eating
Drinking
Salivate
Hide or try to escape
Freeze
Panting
Pace
Refuse food or treat
Bark/Growl
Lunge
Yawn
Chase
Tremble/Shake
Seek out people
Other
How often do noise occure?
Daily
Weekly
Montly
Dog - Human Suggle Information
In response to adult or children, does your dog do any of the following behaviors?
Destructive Behavior
Toileting
Vocalising
Salivating
Pacing
Panting
Eating
Drinking
Salivate
Hide or try to escape
Freeze
Panting
Pace
Refuse food or treat
Bark/Growl
Lunge
Yawn
Chase
Tremble/Shake
Seek out people
Other
What specifically triggers this response?
How often does your dog encounter them?
Daily
Weekly
Monthly
Do any of your other pets have behavioral responses to people?
Dog-Dog Struggle Information
In response to adult dogs or puppies, does your dog do any of the following behaviors?
Destructive Behavior
Toileting
Vocalising
Salivating
Pacing
Panting
Eating
Drinking
Salivate
Hide or try to escape
Freeze
Panting
Pace
Refuse food or treat
Bark/Growl
Lunge
Yawn
Chase
Tremble/Shake
Seek out people
Other
What specifically triggers this response?
How often does your dog encounter them?
Daily
Weekly
Monthly
Do any of your other pets struggle with other dogs?
Resource Guarding Information
In response to a person or dog approaching them when they have a resource (something they value e.g. food, toy, or space), does your dog do any of the following behaviors?
Destructive Behavior
Toileting
Vocalising
Salivating
Pacing
Panting
Eating
Drinking
Salivate
Hide or try to escape
Freeze
Panting
Pace
Refuse food or treat
Bark/Growl
Lunge
Yawn
Chase
Tremble/Shake
Seek out people
Other
What specifically triggers this response?
How often does your dog encounter them?
Daily
Weekly
Montly
Struggle History
What is the problem?
When did if first occur?
Did it occur suddenly or develop slowly over time?
Please Select
Suddenly
Slowly over time
Has it progressed?
Please Select
Yes
No
Is this problem always present?
Please Select
Yes
No
What have you tried in the past to resolve this/these problems?
Submit
Should be Empty: