Behavior Questionnaire

1
Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
Area Code
Phone Number
3
Pets Name* This field is required.
4
What is the main behavior problem you wish to address at this appointment?* This field is required.
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Large
Normal
Small
Ok
Ok
5
Describe the very first incident of this problem. Try to remember the earliest occurrence of the problem, even if it wasn’t as serious as it is now. For instance, if your dog is aggressive to people, describe the first time they growled or barked at someone. Or if your dog has problems being left home alone, describe the first time they whined and cried when you left.* This field is required.Include where the incident occurred, who else (human and animal) was present, what happened just before the incident, how everyone reacted, etc
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Normal
Small
Ok
Ok
6
Date of First Incident (Approximate date is ok)* This field is required.
7
On the date of the first incident, how old was your dog? (Approximate age is ok) * This field is required.
8
Describe the most recent incident of this problem. Try to remember the most recent occurrence of the problem, even if it wasn’t as serious as it is now. For instance, if your dog is aggressive to people, describe the first time they growled or barked at someone. Or if your dog has problems being left home alone, describe the first time they whined and cried when you left.* This field is required.Include where the incident occurred, who else (human and animal) was present, what happened just before the incident, how everyone reacted, etc
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Large
Normal
Small
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Ok
9
Date of the most recent incident? (approximate date is ok)* This field is required.
10
Dog's Age at most recent incident? (Approximate age is ok)* This field is required.
11
Describe the at least one other incident of this problem. Try to remember the occurrence of the problem, even if it wasn’t as serious as it is now. For instance, if your dog is aggressive to people, describe the first time they growled or barked at someone. Or if your dog has problems being left home alone, describe the first time they whined and cried when you left.* This field is required.Include where the incident occurred, who else (human and animal) was present, what happened just before the incident, how everyone reacted, etc
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Large
Normal
Small
Ok
Ok
12
Date of other incident? (Approximate date is ok) * This field is required.
13
Dog's Age at time of other incident? (Approximate age is ok)* This field is required.
14
If you noticed any changes in your dog’s body language or facial expression before, during or after the incidents, please describe.* This field is required.If not, type N/A
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Large
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Small
Ok
Ok
15
What would you like to see as an outcome for your upcoming appointment?* This field is required.
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Large
Normal
Small
Ok
Ok
16
How frequently does this problem occur?* This field is required.
1-6x per week
1-10 times per day
10+ times per day
17
Is the frequency....* This field is required.
Increasing
Decreasing
Unchanged
18
What percentage of the time that your dog is in a potentially problematic situation, does the problem behavior occur?* This field is required.
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
19
Describe what you have tried to correct the problem and what the dog’s response has been to each attempt.* This field is required.
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Large
Normal
Small
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Ok
20
How serious do you and other members of the household find the problem:
Name House member 1 - HM1     Mild     Moderate     Severe     Intolerable
Name House member 2 - HM2     Mild     Moderate     Severe     Intolerable
Name House member 3 - HM3     Mild     Moderate     Severe     Intolerable
Name House member 4 - HM4     Mild     Moderate     Severe     Intolerable
Name House member 5 - HM5     Mild     Moderate     Severe     Intolerable
Name House member 6 - HM6     Mild     Moderate     Severe     Intolerable
21
Household Member 1* This field is required.
House Member 1 Name
House Member 1 Age
Relationship (e.g. Self, Spouse, Son, Daughter, Roommate)
22
Household Member 2
House Member 2 Name
House Member 2 Age
House Member 2 Relationship (e.g. Self, Spouse, Son, Daughter, Roommate,)
23
Household Member 3
House Member 3 Name
House Member 3 Age
Household Member 3 Relationship (e.g. Self, Spouse, Son, Daughter, Roommate)
24
Household Member 4
House Member 4 Name
House Member 4 Age
Household Member 4 Relationship (e.g. Self, Spouse, Son, Daughter, Roommate)
25
Household Member 5
House Member 5 Name
House Member 5 Age
Household Member 5 Relationship (e.g. Self, Spouse, Son, Daughter, Roommate)
26
Household Member 6
House Member 6 Name
House Member 6 Age
Household Member 6 Relationship (e.g. Self, Spouse, Son, Daughter, Roommate)
27
Other People in Regular Contact With PetNon-Household Members
Non-Household Member 1 Name
Non-Household Member 1 Age
Non-Household Member 1 Relationship (e.g. pet sitter, housekeepers, relatives, friends, etc)
28
Other People in Regular Contact With PetNon-Household Members
Non-Household Member 2 Name
Non-Household Member 2 Age
Non-Household Member 2 Relationship (e.g. pet sitter, housekeepers, relatives, friends, etc)
29
Other People in Regular Contact With PetNon-Household Members
Non-Household Member 3 Name
Non-Household Member 3 Age
Non-Household Member 3 Relationship (e.g. pet sitter, housekeepers, relatives, friends, etc)
30
Other People in Regular Contact With PetNon-Household Members
Non-Household Member 4 Name
Non-Household Member 4 Age
Non-Household Member 4 Relationship (e.g. pet sitter, housekeepers, relatives, friends, etc)
31
Other People in Regular Contact With PetNon-Household Members
Non-Household Member 5 Name
Non-Household Member 5 Age
Non-Household Member 5 Relationship (e.g. pet sitter, housekeepers, relatives, friends, etc)
32
Type of house* This field is required.
Single Family Detached
Apartment
Attached/Townhouse
Mobile Home
Other
33
Neighborhood* This field is required.
Urban
Suburban
Rural
34
Do you have a yard? If yes, how big is it?* This field is required.
35
Is the yard fenced? If yes, height of fence?* This field is required.Type N/A if no fence
36
Type of fence: (e.g. wooden salts, solid, wrought iron, chain link etc)* This field is required.If no fence, type N/A
37
Other pet(s) in homePet 1
Name
Species (e.g. dog, cat etc)
Breed (e.g. Golden Retriever, Manx, etc)
Current Age
Age When Obtained
38
Other pet(s) in homePet 2
Name
Species (e.g. dog, cat etc)
Breed (e.g. Golden Retriever, Manx, etc)
Current Age
Age When Obtained
39
Other pet(s) in homePet 3
Name
Species (e.g. dog, cat etc)
Breed (e.g. Golden Retriever, Manx, etc)
Current Age
Age When Obtained
40
Other pet(s) in homePet 4
Name
Species (e.g. dog, cat etc)
Breed (e.g. Golden Retriever, Manx, etc)
Current Age
Age When Obtained
41
How old was this dog when you acquired?* This field is required.
42
Where did you obtain this dog? (Performance breeder - show, hunting, agility, etc/ Hobby breeder/ Private Home/ Previous Owner/ Shelter/ Rescue/ Pet Store/ Other)* This field is required.
43
Behavior of dog's parents/ littermates (If known)
44
Describe previous home (If known)
45
List any major illnesses/surgeries (dates):
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Large
Normal
Small
Ok
Ok
46
List ALL medications/treatments your dog is currently receiving, including heart worm, flea preventative, dietary supplements, herbal/homeopathic treatments:* This field is required.If none, type N/A
Medication 1 Name
Strength
Dosing Instructions (e.g. give 1 tablet every 12 hour, give 1 tablet once daily)
Date Started Medication
47
List ALL medications/treatments your dog is currently receiving, including heart worm, flea preventative, dietary supplements, herbal/homeopathic treatments:If none, type N/A
Medication 2 Name
Strength
Dosing Instructions (e.g. give 1 tablet every 12 hour, give 1 tablet once daily)
Date Started Medication
48
List ALL medications/treatments your dog is currently receiving, including heart worm, flea preventative, dietary supplements, herbal/homeopathic treatments:If none, type N/A
Medication 3 Name
Strength
Dosing Instructions (e.g. give 1 tablet every 12 hour, give 1 tablet once daily)
Date Started Medication
49
List ALL medications/treatments your dog is currently receiving, including heart worm, flea preventative, dietary supplements, herbal/homeopathic treatments:If none, type N/A
Medication 4 Name
Strength
Dosing Instructions (e.g. give 1 tablet every 12 hour, give 1 tablet once daily)
Date Started Medication
50
List ALL medications/treatments your dog is currently receiving, including heart worm, flea preventative, dietary supplements, herbal/homeopathic treatments:If none, type N/A
Medication 5 Name
Strength
Dosing Instructions (e.g. give 1 tablet every 12 hour, give 1 tablet once daily)
Date Started Medication
51
List ALL medications/treatments your dog is currently receiving, including heart worm, flea preventative, dietary supplements, herbal/homeopathic treatments:If none, type N/A
Medication 6 Name
Strength
Dosing Instructions (e.g. give 1 tablet every 12 hour, give 1 tablet once daily)
Date Started Medication
52
Feeding:* This field is required.
When and where is the dog fed?
Who feeds the dog?
53
Type of food:* This field is required.
Dry Food - Brand
% of pet's diet
Canned - Brand
% of pet's diet
Raw
% of pet's diet
People food
% of pet's diet
54
Eating habits* This field is required.Check all that apply
Eats right away
Picky eater
Anxious eater
Guards food from people
Guards food from dogs
Other
55
Where does your dog sleep at night?* This field is required.
56
If disturbed while sleeping, what is your dog’s reaction?* This field is required.Check all that apply
Happy
Startled
Growls
Barks
Bites
Scared
Grumpy
Playful
Other
57
Exercise: Leash Walks - Does your dog get regular leash walks?* This field is required.
YESNO
58
If NO, why?Check all that apply
Doesn’t walk well (pulls) on lead
Aggressive on walks
Don’t have the time
Medical reasons
Other
59
If YES:
Who takes the dog for leash walks?
How often?
How long are the walks?
Location (e.g. around neighborhood, in town, in park)
60
What do you use to walk the dog?Check all that apply
Flat buckle collar
Body harness
Head collar (Halti, Gentle Leader)
Training/choke collar
Prong collar
Retractable leash
Long leash (6 ft+)
Average leash (4-6 ft)
Short leash (4 ft or less0
Other
61
How is your dog on leash?Please choose one
Excellent (never pulls, pays attention to me)
Good (rarely pulls)
Fair (pulls but I’m able to control)
Poor (pulls a lot, difficult to control)
Bad (pulls, I don’t enjoy walks)
62
Off-Leash Exercise: Does your dog get off-leash exercise?* This field is required.
YESNO
63
If yes:
Who takes the dog for off leash exercise?
How often?
For how long?
Location (e.g. trails, dog parks, beaches)
64
Living Spaces/Being Left Alone: Where does your dog spend the most time when people are home:* This field is required.Check all that apply
Loose in house - No acces to outside
Loose in house - With access to outside
Confined to part of the house (e.g. with gates) - No access to outside
Confined to part of the house (e.g. with gates) - With access to outside
Inside a crate or pen
Loose in yard
Outside in a kennel or pen
Other
65
Where does your dog spend the most time when people are not home?* This field is required.Check all that apply
Loose in the house - With access to outside
Loose in the house - No access to the outside
Confined to part of the house (e.g. with gates) - With access to the outside
Confined to part of the house (e.g. with gates) - No access to the outside
Inside a crate or pen
Loose in the yard
Outside in a kennel or pen
Other
66
Being left alone:* This field is required.
How long is your dog left alone on an average day?
When is your dog left alone? (e.g. 8am to 5pm)
67
What is your dog’s reaction to being left alone?* This field is required.Check all that apply
Calm
Depressed
Barks
Cries/Howls
Urinates/Defecates
Escapes
Destructive
Anxious
Excited
Aggressive
Other
68
Describe a typical 24 hour day in your dog’s life, starting with when and where the dog wakes up in the morning. Include feeding, exercise and play times. If behavior.problems occur at particular times of the day, include that information.* This field is required.
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Large
Normal
Small
Ok
Ok
69
Has your dog had any training?* This field is required.Please choose one answer
No
Trained ourselves
Classes
Met with trainer
Other
70
Under each type of class, at what age did pet attend and name of trainer(s)* This field is required.Enter N/A if never done
Puppy Classes
Group Classes
Private Lessons
Board & Train
Other (Please list type)
71
What training techniques or tools have you used?* This field is required.Check all that apply
Training collar (choke)
Food rewards
Verbal praise
Play/toys
Prong collar
Remote collar - Citronella
Remote collar - Shock
Remote collar - Vibration
Bark collars - Shock
Bark collars - Vibration
Bark collars - Citronella
Other
72
Who in the household trained the dog?* This field is required.If multiple people, please list
73
What commands does your dog know?* This field is required.
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Large
Normal
Small
Ok
Ok
74
Did your dog enjoy training?* This field is required.
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Large
Normal
Small
Ok
Ok
75
How well does your dog obey commands WITHOUT distractions?* This field is required.
Very Well
Well
Fairly Well
Poorly
Does not follow commands
76
How well does your dog obey commands WITH distractions?* This field is required.
Very Well
Well
Fairly Well
Poorly
Does not follow commands
77
Does your dog engage in the following behaviors at least weekly?* This field is required.
No
When Owner Present 1-3x week
When Owner Present 4-6x week
When Owner Present Daily
When Owner NOT Present 1-3x week
When Owner NOT Present 4-6x week
When Owner NOT Present Daily
Housesoiling
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Excessive barking/whining
Row 1, Column 0
Row 1, Column 1
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Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Destructive chewing
Row 2, Column 0
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Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Self licking/chewing
Row 3, Column 0
Row 3, Column 1
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Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Pacing/repetitive behavior
Row 4, Column 0
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Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Consuming non-food objects
Row 5, Column 0
Row 5, Column 1
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Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Circling/chasing tail/freezing
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
Row 6, Column 6
Housesoiling
Excessive barking/whining
Destructive chewing
Self licking/chewing
Pacing/repetitive behavior
Consuming non-food objects
Circling/chasing tail/freezing
No
Row 0, Column 0
When Owner Present 1-3x week
Row 0, Column 1
When Owner Present 4-6x week
Row 0, Column 2
When Owner Present Daily
Row 0, Column 3
When Owner NOT Present 1-3x week
Row 0, Column 4
When Owner NOT Present 4-6x week
Row 0, Column 5
When Owner NOT Present Daily
Row 0, Column 6
No
Row 1, Column 0
When Owner Present 1-3x week
Row 1, Column 1
When Owner Present 4-6x week
Row 1, Column 2
When Owner Present Daily
Row 1, Column 3
When Owner NOT Present 1-3x week
Row 1, Column 4
When Owner NOT Present 4-6x week
Row 1, Column 5
When Owner NOT Present Daily
Row 1, Column 6
No
Row 2, Column 0
When Owner Present 1-3x week
Row 2, Column 1
When Owner Present 4-6x week
Row 2, Column 2
When Owner Present Daily
Row 2, Column 3
When Owner NOT Present 1-3x week
Row 2, Column 4
When Owner NOT Present 4-6x week
Row 2, Column 5
When Owner NOT Present Daily
Row 2, Column 6
No
Row 3, Column 0
When Owner Present 1-3x week
Row 3, Column 1
When Owner Present 4-6x week
Row 3, Column 2
When Owner Present Daily
Row 3, Column 3
When Owner NOT Present 1-3x week
Row 3, Column 4
When Owner NOT Present 4-6x week
Row 3, Column 5
When Owner NOT Present Daily
Row 3, Column 6
No
Row 4, Column 0
When Owner Present 1-3x week
Row 4, Column 1
When Owner Present 4-6x week
Row 4, Column 2
When Owner Present Daily
Row 4, Column 3
When Owner NOT Present 1-3x week
Row 4, Column 4
When Owner NOT Present 4-6x week
Row 4, Column 5
When Owner NOT Present Daily
Row 4, Column 6
No
Row 5, Column 0
When Owner Present 1-3x week
Row 5, Column 1
When Owner Present 4-6x week
Row 5, Column 2
When Owner Present Daily
Row 5, Column 3
When Owner NOT Present 1-3x week
Row 5, Column 4
When Owner NOT Present 4-6x week
Row 5, Column 5
When Owner NOT Present Daily
Row 5, Column 6
No
Row 6, Column 0
When Owner Present 1-3x week
Row 6, Column 1
When Owner Present 4-6x week
Row 6, Column 2
When Owner Present Daily
Row 6, Column 3
When Owner NOT Present 1-3x week
Row 6, Column 4
When Owner NOT Present 4-6x week
Row 6, Column 5
When Owner NOT Present Daily
Row 6, Column 6
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78
How does your dog react to the following?* This field is required.
Happy
Neutral
Fear/ Anxiety/ Submits
Snarl
Bark/ Growl
Snap/ Bite
Don’t Know/ Doesn’t Do
Unfamiliar People at door
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Unfamiliar people in home
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Unfamiliar people, neutral territory, ON leash
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Unfamiliar people, neutral territory, OFF leash
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Unfamiliar people neutral territory approaching/trying to pet
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Children on bicycles, roller blades
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Joggers (adult)
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
Row 6, Column 6
Cars/trucks going by, on leash
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
Row 7, Column 6
Babies
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 8, Column 5
Row 8, Column 6
Children
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Row 9, Column 5
Row 9, Column 6
Unfamiliar dogs, ON leash
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Row 10, Column 5
Row 10, Column 6
Unfamiliar dogs, OFF leash
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Row 11, Column 5
Row 11, Column 6
Squirrels/cats/small animals approaching dog
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Row 12, Column 5
Row 12, Column 6
Person passing when dog in yard
Row 13, Column 0
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Row 13, Column 2
Row 13, Column 3
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Row 13, Column 5
Row 13, Column 6
Dog passing when dog is in yard
Row 14, Column 0
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Row 14, Column 2
Row 14, Column 3
Row 14, Column 4
Row 14, Column 5
Row 14, Column 6
Veterinary visits
Row 15, Column 0
Row 15, Column 1
Row 15, Column 2
Row 15, Column 3
Row 15, Column 4
Row 15, Column 5
Row 15, Column 6
Owners leaving
Row 16, Column 0
Row 16, Column 1
Row 16, Column 2
Row 16, Column 3
Row 16, Column 4
Row 16, Column 5
Row 16, Column 6
Owners returning
Row 17, Column 0
Row 17, Column 1
Row 17, Column 2
Row 17, Column 3
Row 17, Column 4
Row 17, Column 5
Row 17, Column 6
Car rides
Row 18, Column 0
Row 18, Column 1
Row 18, Column 2
Row 18, Column 3
Row 18, Column 4
Row 18, Column 5
Row 18, Column 6
Thunder
Row 19, Column 0
Row 19, Column 1
Row 19, Column 2
Row 19, Column 3
Row 19, Column 4
Row 19, Column 5
Row 19, Column 6
Loud noises
Row 20, Column 0
Row 20, Column 1
Row 20, Column 2
Row 20, Column 3
Row 20, Column 4
Row 20, Column 5
Row 20, Column 6
Rough housing
Row 21, Column 0
Row 21, Column 1
Row 21, Column 2
Row 21, Column 3
Row 21, Column 4
Row 21, Column 5
Row 21, Column 6
Unfamiliar People at door
Unfamiliar people in home
Unfamiliar people, neutral territory, ON leash
Unfamiliar people, neutral territory, OFF leash
Unfamiliar people neutral territory approaching/trying to pet
Children on bicycles, roller blades
Joggers (adult)
Cars/trucks going by, on leash
Babies
Children
Unfamiliar dogs, ON leash
Unfamiliar dogs, OFF leash
Squirrels/cats/small animals approaching dog
Person passing when dog in yard
Dog passing when dog is in yard
Veterinary visits
Owners leaving
Owners returning
Car rides
Thunder
Loud noises
Rough housing
Happy
Row 0, Column 0
Neutral
Row 0, Column 1
Fear/ Anxiety/ Submits
Row 0, Column 2
Snarl
Row 0, Column 3
Bark/ Growl
Row 0, Column 4
Snap/ Bite
Row 0, Column 5
Don’t Know/ Doesn’t Do
Row 0, Column 6
Happy
Row 1, Column 0
Neutral
Row 1, Column 1
Fear/ Anxiety/ Submits
Row 1, Column 2
Snarl
Row 1, Column 3
Bark/ Growl
Row 1, Column 4
Snap/ Bite
Row 1, Column 5
Don’t Know/ Doesn’t Do
Row 1, Column 6
Happy
Row 2, Column 0
Neutral
Row 2, Column 1
Fear/ Anxiety/ Submits
Row 2, Column 2
Snarl
Row 2, Column 3
Bark/ Growl
Row 2, Column 4
Snap/ Bite
Row 2, Column 5
Don’t Know/ Doesn’t Do
Row 2, Column 6
Happy
Row 3, Column 0
Neutral
Row 3, Column 1
Fear/ Anxiety/ Submits
Row 3, Column 2
Snarl
Row 3, Column 3
Bark/ Growl
Row 3, Column 4
Snap/ Bite
Row 3, Column 5
Don’t Know/ Doesn’t Do
Row 3, Column 6
Happy
Row 4, Column 0
Neutral
Row 4, Column 1
Fear/ Anxiety/ Submits
Row 4, Column 2
Snarl
Row 4, Column 3
Bark/ Growl
Row 4, Column 4
Snap/ Bite
Row 4, Column 5
Don’t Know/ Doesn’t Do
Row 4, Column 6
Happy
Row 5, Column 0
Neutral
Row 5, Column 1
Fear/ Anxiety/ Submits
Row 5, Column 2
Snarl
Row 5, Column 3
Bark/ Growl
Row 5, Column 4
Snap/ Bite
Row 5, Column 5
Don’t Know/ Doesn’t Do
Row 5, Column 6
Happy
Row 6, Column 0
Neutral
Row 6, Column 1
Fear/ Anxiety/ Submits
Row 6, Column 2
Snarl
Row 6, Column 3
Bark/ Growl
Row 6, Column 4
Snap/ Bite
Row 6, Column 5
Don’t Know/ Doesn’t Do
Row 6, Column 6
Happy
Row 7, Column 0
Neutral
Row 7, Column 1
Fear/ Anxiety/ Submits
Row 7, Column 2
Snarl
Row 7, Column 3
Bark/ Growl
Row 7, Column 4
Snap/ Bite
Row 7, Column 5
Don’t Know/ Doesn’t Do
Row 7, Column 6
Happy
Row 8, Column 0
Neutral
Row 8, Column 1
Fear/ Anxiety/ Submits
Row 8, Column 2
Snarl
Row 8, Column 3
Bark/ Growl
Row 8, Column 4
Snap/ Bite
Row 8, Column 5
Don’t Know/ Doesn’t Do
Row 8, Column 6
Happy
Row 9, Column 0
Neutral
Row 9, Column 1
Fear/ Anxiety/ Submits
Row 9, Column 2
Snarl
Row 9, Column 3
Bark/ Growl
Row 9, Column 4
Snap/ Bite
Row 9, Column 5
Don’t Know/ Doesn’t Do
Row 9, Column 6
Happy
Row 10, Column 0
Neutral
Row 10, Column 1
Fear/ Anxiety/ Submits
Row 10, Column 2
Snarl
Row 10, Column 3
Bark/ Growl
Row 10, Column 4
Snap/ Bite
Row 10, Column 5
Don’t Know/ Doesn’t Do
Row 10, Column 6
Happy
Row 11, Column 0
Neutral
Row 11, Column 1
Fear/ Anxiety/ Submits
Row 11, Column 2
Snarl
Row 11, Column 3
Bark/ Growl
Row 11, Column 4
Snap/ Bite
Row 11, Column 5
Don’t Know/ Doesn’t Do
Row 11, Column 6
Happy
Row 12, Column 0
Neutral
Row 12, Column 1
Fear/ Anxiety/ Submits
Row 12, Column 2
Snarl
Row 12, Column 3
Bark/ Growl
Row 12, Column 4
Snap/ Bite
Row 12, Column 5
Don’t Know/ Doesn’t Do
Row 12, Column 6
Happy
Row 13, Column 0
Neutral
Row 13, Column 1
Fear/ Anxiety/ Submits
Row 13, Column 2
Snarl
Row 13, Column 3
Bark/ Growl
Row 13, Column 4
Snap/ Bite
Row 13, Column 5
Don’t Know/ Doesn’t Do
Row 13, Column 6
Happy
Row 14, Column 0
Neutral
Row 14, Column 1
Fear/ Anxiety/ Submits
Row 14, Column 2
Snarl
Row 14, Column 3
Bark/ Growl
Row 14, Column 4
Snap/ Bite
Row 14, Column 5
Don’t Know/ Doesn’t Do
Row 14, Column 6
Happy
Row 15, Column 0
Neutral
Row 15, Column 1
Fear/ Anxiety/ Submits
Row 15, Column 2
Snarl
Row 15, Column 3
Bark/ Growl
Row 15, Column 4
Snap/ Bite
Row 15, Column 5
Don’t Know/ Doesn’t Do
Row 15, Column 6
Happy
Row 16, Column 0
Neutral
Row 16, Column 1
Fear/ Anxiety/ Submits
Row 16, Column 2
Snarl
Row 16, Column 3
Bark/ Growl
Row 16, Column 4
Snap/ Bite
Row 16, Column 5
Don’t Know/ Doesn’t Do
Row 16, Column 6
Happy
Row 17, Column 0
Neutral
Row 17, Column 1
Fear/ Anxiety/ Submits
Row 17, Column 2
Snarl
Row 17, Column 3
Bark/ Growl
Row 17, Column 4
Snap/ Bite
Row 17, Column 5
Don’t Know/ Doesn’t Do
Row 17, Column 6
Happy
Row 18, Column 0
Neutral
Row 18, Column 1
Fear/ Anxiety/ Submits
Row 18, Column 2
Snarl
Row 18, Column 3
Bark/ Growl
Row 18, Column 4
Snap/ Bite
Row 18, Column 5
Don’t Know/ Doesn’t Do
Row 18, Column 6
Happy
Row 19, Column 0
Neutral
Row 19, Column 1
Fear/ Anxiety/ Submits
Row 19, Column 2
Snarl
Row 19, Column 3
Bark/ Growl
Row 19, Column 4
Snap/ Bite
Row 19, Column 5
Don’t Know/ Doesn’t Do
Row 19, Column 6
Happy
Row 20, Column 0
Neutral
Row 20, Column 1
Fear/ Anxiety/ Submits
Row 20, Column 2
Snarl
Row 20, Column 3
Bark/ Growl
Row 20, Column 4
Snap/ Bite
Row 20, Column 5
Don’t Know/ Doesn’t Do
Row 20, Column 6
Happy
Row 21, Column 0
Neutral
Row 21, Column 1
Fear/ Anxiety/ Submits
Row 21, Column 2
Snarl
Row 21, Column 3
Bark/ Growl
Row 21, Column 4
Snap/ Bite
Row 21, Column 5
Don’t Know/ Doesn’t Do
Row 21, Column 6
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79
How does your dog react when a family member does the following:* This field is required.
Happy
Neutral
Fear/ Anxiety/ Submits
Snarl
Bark/ Growl
Snap/ Bite
Don’t know/ Doesn’t Do
Walk by food while dog eats food
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Take food dish while dog eats
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Take away non-edible toy
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Take away bone/rawhide
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Reach for dropped food at same time as dog
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Reach over head/ pet on top of head
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Pet on other parts of body
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
Row 6, Column 6
Brush
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
Row 7, Column 6
Bathe
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 8, Column 5
Row 8, Column 6
Pick dog up
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Row 9, Column 5
Row 9, Column 6
Put on/take off collar
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Row 10, Column 5
Row 10, Column 6
Put on/take off leash
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Row 11, Column 5
Row 11, Column 6
Disturb while sleeping
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Row 12, Column 5
Row 12, Column 6
Move while on furniture
Row 13, Column 0
Row 13, Column 1
Row 13, Column 2
Row 13, Column 3
Row 13, Column 4
Row 13, Column 5
Row 13, Column 6
Approach the dog when it’s sitting with a favorite person
Row 14, Column 0
Row 14, Column 1
Row 14, Column 2
Row 14, Column 3
Row 14, Column 4
Row 14, Column 5
Row 14, Column 6
Hold back when excited (e.g. from running out door) NOT WHEN AGGRESSIVE
Row 15, Column 0
Row 15, Column 1
Row 15, Column 2
Row 15, Column 3
Row 15, Column 4
Row 15, Column 5
Row 15, Column 6
Hold back when aggressive (e.g. barking at another dog)
Row 16, Column 0
Row 16, Column 1
Row 16, Column 2
Row 16, Column 3
Row 16, Column 4
Row 16, Column 5
Row 16, Column 6
Verbal reprimand
Row 17, Column 0
Row 17, Column 1
Row 17, Column 2
Row 17, Column 3
Row 17, Column 4
Row 17, Column 5
Row 17, Column 6
Leash correction
Row 18, Column 0
Row 18, Column 1
Row 18, Column 2
Row 18, Column 3
Row 18, Column 4
Row 18, Column 5
Row 18, Column 6
Physical reprimand
Row 19, Column 0
Row 19, Column 1
Row 19, Column 2
Row 19, Column 3
Row 19, Column 4
Row 19, Column 5
Row 19, Column 6
Staring at the dog
Row 20, Column 0
Row 20, Column 1
Row 20, Column 2
Row 20, Column 3
Row 20, Column 4
Row 20, Column 5
Row 20, Column 6
Walk by food while dog eats food
Take food dish while dog eats
Take away non-edible toy
Take away bone/rawhide
Reach for dropped food at same time as dog
Reach over head/ pet on top of head
Pet on other parts of body
Brush
Bathe
Pick dog up
Put on/take off collar
Put on/take off leash
Disturb while sleeping
Move while on furniture
Approach the dog when it’s sitting with a favorite person
Hold back when excited (e.g. from running out door) NOT WHEN AGGRESSIVE
Hold back when aggressive (e.g. barking at another dog)
Verbal reprimand
Leash correction
Physical reprimand
Staring at the dog
Happy
Row 0, Column 0
Neutral
Row 0, Column 1
Fear/ Anxiety/ Submits
Row 0, Column 2
Snarl
Row 0, Column 3
Bark/ Growl
Row 0, Column 4
Snap/ Bite
Row 0, Column 5
Don’t know/ Doesn’t Do
Row 0, Column 6
Happy
Row 1, Column 0
Neutral
Row 1, Column 1
Fear/ Anxiety/ Submits
Row 1, Column 2
Snarl
Row 1, Column 3
Bark/ Growl
Row 1, Column 4
Snap/ Bite
Row 1, Column 5
Don’t know/ Doesn’t Do
Row 1, Column 6
Happy
Row 2, Column 0
Neutral
Row 2, Column 1
Fear/ Anxiety/ Submits
Row 2, Column 2
Snarl
Row 2, Column 3
Bark/ Growl
Row 2, Column 4
Snap/ Bite
Row 2, Column 5
Don’t know/ Doesn’t Do
Row 2, Column 6
Happy
Row 3, Column 0
Neutral
Row 3, Column 1
Fear/ Anxiety/ Submits
Row 3, Column 2
Snarl
Row 3, Column 3
Bark/ Growl
Row 3, Column 4
Snap/ Bite
Row 3, Column 5
Don’t know/ Doesn’t Do
Row 3, Column 6
Happy
Row 4, Column 0
Neutral
Row 4, Column 1
Fear/ Anxiety/ Submits
Row 4, Column 2
Snarl
Row 4, Column 3
Bark/ Growl
Row 4, Column 4
Snap/ Bite
Row 4, Column 5
Don’t know/ Doesn’t Do
Row 4, Column 6
Happy
Row 5, Column 0
Neutral
Row 5, Column 1
Fear/ Anxiety/ Submits
Row 5, Column 2
Snarl
Row 5, Column 3
Bark/ Growl
Row 5, Column 4
Snap/ Bite
Row 5, Column 5
Don’t know/ Doesn’t Do
Row 5, Column 6
Happy
Row 6, Column 0
Neutral
Row 6, Column 1
Fear/ Anxiety/ Submits
Row 6, Column 2
Snarl
Row 6, Column 3
Bark/ Growl
Row 6, Column 4
Snap/ Bite
Row 6, Column 5
Don’t know/ Doesn’t Do
Row 6, Column 6
Happy
Row 7, Column 0
Neutral
Row 7, Column 1
Fear/ Anxiety/ Submits
Row 7, Column 2
Snarl
Row 7, Column 3
Bark/ Growl
Row 7, Column 4
Snap/ Bite
Row 7, Column 5
Don’t know/ Doesn’t Do
Row 7, Column 6
Happy
Row 8, Column 0
Neutral
Row 8, Column 1
Fear/ Anxiety/ Submits
Row 8, Column 2
Snarl
Row 8, Column 3
Bark/ Growl
Row 8, Column 4
Snap/ Bite
Row 8, Column 5
Don’t know/ Doesn’t Do
Row 8, Column 6
Happy
Row 9, Column 0
Neutral
Row 9, Column 1
Fear/ Anxiety/ Submits
Row 9, Column 2
Snarl
Row 9, Column 3
Bark/ Growl
Row 9, Column 4
Snap/ Bite
Row 9, Column 5
Don’t know/ Doesn’t Do
Row 9, Column 6
Happy
Row 10, Column 0
Neutral
Row 10, Column 1
Fear/ Anxiety/ Submits
Row 10, Column 2
Snarl
Row 10, Column 3
Bark/ Growl
Row 10, Column 4
Snap/ Bite
Row 10, Column 5
Don’t know/ Doesn’t Do
Row 10, Column 6
Happy
Row 11, Column 0
Neutral
Row 11, Column 1
Fear/ Anxiety/ Submits
Row 11, Column 2
Snarl
Row 11, Column 3
Bark/ Growl
Row 11, Column 4
Snap/ Bite
Row 11, Column 5
Don’t know/ Doesn’t Do
Row 11, Column 6
Happy
Row 12, Column 0
Neutral
Row 12, Column 1
Fear/ Anxiety/ Submits
Row 12, Column 2
Snarl
Row 12, Column 3
Bark/ Growl
Row 12, Column 4
Snap/ Bite
Row 12, Column 5
Don’t know/ Doesn’t Do
Row 12, Column 6
Happy
Row 13, Column 0
Neutral
Row 13, Column 1
Fear/ Anxiety/ Submits
Row 13, Column 2
Snarl
Row 13, Column 3
Bark/ Growl
Row 13, Column 4
Snap/ Bite
Row 13, Column 5
Don’t know/ Doesn’t Do
Row 13, Column 6
Happy
Row 14, Column 0
Neutral
Row 14, Column 1
Fear/ Anxiety/ Submits
Row 14, Column 2
Snarl
Row 14, Column 3
Bark/ Growl
Row 14, Column 4
Snap/ Bite
Row 14, Column 5
Don’t know/ Doesn’t Do
Row 14, Column 6
Happy
Row 15, Column 0
Neutral
Row 15, Column 1
Fear/ Anxiety/ Submits
Row 15, Column 2
Snarl
Row 15, Column 3
Bark/ Growl
Row 15, Column 4
Snap/ Bite
Row 15, Column 5
Don’t know/ Doesn’t Do
Row 15, Column 6
Happy
Row 16, Column 0
Neutral
Row 16, Column 1
Fear/ Anxiety/ Submits
Row 16, Column 2
Snarl
Row 16, Column 3
Bark/ Growl
Row 16, Column 4
Snap/ Bite
Row 16, Column 5
Don’t know/ Doesn’t Do
Row 16, Column 6
Happy
Row 17, Column 0
Neutral
Row 17, Column 1
Fear/ Anxiety/ Submits
Row 17, Column 2
Snarl
Row 17, Column 3
Bark/ Growl
Row 17, Column 4
Snap/ Bite
Row 17, Column 5
Don’t know/ Doesn’t Do
Row 17, Column 6
Happy
Row 18, Column 0
Neutral
Row 18, Column 1
Fear/ Anxiety/ Submits
Row 18, Column 2
Snarl
Row 18, Column 3
Bark/ Growl
Row 18, Column 4
Snap/ Bite
Row 18, Column 5
Don’t know/ Doesn’t Do
Row 18, Column 6
Happy
Row 19, Column 0
Neutral
Row 19, Column 1
Fear/ Anxiety/ Submits
Row 19, Column 2
Snarl
Row 19, Column 3
Bark/ Growl
Row 19, Column 4
Snap/ Bite
Row 19, Column 5
Don’t know/ Doesn’t Do
Row 19, Column 6
Happy
Row 20, Column 0
Neutral
Row 20, Column 1
Fear/ Anxiety/ Submits
Row 20, Column 2
Snarl
Row 20, Column 3
Bark/ Growl
Row 20, Column 4
Snap/ Bite
Row 20, Column 5
Don’t know/ Doesn’t Do
Row 20, Column 6
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80
How does your dog react to a dog in the household?* This field is required.
Happy
Neutral
Fear/ Anxiety/ Submits
Snarl
Bark/ Growl
Snap/ Bite
Don’t Know/ Doesn’t Do
Around regular food
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Around rawhides
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Around treats
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Around toys
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Around favorite people
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
While on walks together
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
During play
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
Row 6, Column 6
Around regular food
Around rawhides
Around treats
Around toys
Around favorite people
While on walks together
During play
Happy
Row 0, Column 0
Neutral
Row 0, Column 1
Fear/ Anxiety/ Submits
Row 0, Column 2
Snarl
Row 0, Column 3
Bark/ Growl
Row 0, Column 4
Snap/ Bite
Row 0, Column 5
Don’t Know/ Doesn’t Do
Row 0, Column 6
Happy
Row 1, Column 0
Neutral
Row 1, Column 1
Fear/ Anxiety/ Submits
Row 1, Column 2
Snarl
Row 1, Column 3
Bark/ Growl
Row 1, Column 4
Snap/ Bite
Row 1, Column 5
Don’t Know/ Doesn’t Do
Row 1, Column 6
Happy
Row 2, Column 0
Neutral
Row 2, Column 1
Fear/ Anxiety/ Submits
Row 2, Column 2
Snarl
Row 2, Column 3
Bark/ Growl
Row 2, Column 4
Snap/ Bite
Row 2, Column 5
Don’t Know/ Doesn’t Do
Row 2, Column 6
Happy
Row 3, Column 0
Neutral
Row 3, Column 1
Fear/ Anxiety/ Submits
Row 3, Column 2
Snarl
Row 3, Column 3
Bark/ Growl
Row 3, Column 4
Snap/ Bite
Row 3, Column 5
Don’t Know/ Doesn’t Do
Row 3, Column 6
Happy
Row 4, Column 0
Neutral
Row 4, Column 1
Fear/ Anxiety/ Submits
Row 4, Column 2
Snarl
Row 4, Column 3
Bark/ Growl
Row 4, Column 4
Snap/ Bite
Row 4, Column 5
Don’t Know/ Doesn’t Do
Row 4, Column 6
Happy
Row 5, Column 0
Neutral
Row 5, Column 1
Fear/ Anxiety/ Submits
Row 5, Column 2
Snarl
Row 5, Column 3
Bark/ Growl
Row 5, Column 4
Snap/ Bite
Row 5, Column 5
Don’t Know/ Doesn’t Do
Row 5, Column 6
Happy
Row 6, Column 0
Neutral
Row 6, Column 1
Fear/ Anxiety/ Submits
Row 6, Column 2
Snarl
Row 6, Column 3
Bark/ Growl
Row 6, Column 4
Snap/ Bite
Row 6, Column 5
Don’t Know/ Doesn’t Do
Row 6, Column 6
1 of 7
81
Has your dog ever bitten a person?* This field is required.
YESNO
82
If yes, describe the victim(s): age, gender and actions (e.g. 10 year old boy waving a stick). * This field is required.Type N/A if answer was no.
Huge
Large
Normal
Small
Ok
Ok
83
How bad was the worst bite your dog gave to a person?* This field is required.Check all that apply
Made contact but didn’t leave a mark
Small red mark
Bruised, didn’t break skin
Broke skin, minor scrape
Broke skin, punctures
Multiple punctures
Punctures and tore flesh
Multiple bites at one time
Required emergency treatment
No bite history
Should be Empty: