The Good Steward Training Company's Behavior & Welfare Pre-Consultation Questionnaire
We appreciate you taking the time to fill out this form thoroughly! This form provides us with the necessary information to best serve you and your animal companion. Please answer ALL of the questions in this form. If something does not apply to your animal companion, please note this in the answer box.
Getting to Know You
What is the name of the animal(s) you are seeking assistance for?
How should we refer to you?
First Name
Last Name
What are your pronouns?
Please List Your Primary Email Address:
example@example.com
Please List Your Home Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please List Your Primary Phone Number:
Please enter a valid phone number.
May we text you at this number?
Yes
No
Please let us know how you found us!
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I am seeking assistance because my animal companion:
Has no current "behavioral issues", but I need to teach them important skills and behaviors.
Has a few undesired behaviors I would like to address, and needs to learn skills and cues.
Has several undesired behaviors I would like to address, but has not demonstrated severe fear, reactivity, or aggression.
Has recently developed significant fear, aggression, or reactivity.
Has a long history of significant fear, aggression, or reactivity.
Please briefly describe any behaviors you would like to reduce or eliminate through our time together. For example: "barking and lunging at dogs on walks", "chewing the table and chair when we're not home"
Please briefly describe other goals you have with your animal companion. For example: "crate training", "being more confident in new places", "learning down with stay", "trick training title"
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Getting to Know Your Animal Companion
What is their name?
What Breed are they? For mixed breeds, please note if you have done a DNA test to make this determination.
What is their sex and status?
Spayed Female
Intact Female
Neutered Male
Intact Male
How old are they?
If you are seeking welfare and behavior assistance for more than one individual, please fill out a separate form for each.
This is the only animal
I will be filling out multiple forms
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Medical History
Please list your current veterinarian's Name and Phone Number
Do we have your permission to request your pet's medical records from this vet?
Yes
No, I will email them to you
Is your animal companion up to date on their rabies vaccine?
Yes
No
When was your animal companion given their most recent rabies vaccine?
-
Month
-
Day
Year
Date
Was this a 1 year or 3 year vaccine?
1 Year
3 Year
What is your animal companion's heartworm status?
Heartworm Negative
Heartworm Positive
Unknown
When was the date of their last heartworm test?
-
Month
-
Day
Year
Date
What monthly preventative do you utilize to combat fleas, ticks, and heartworm?
Does your animal companion have any food allergies or food sensitivities?
Yes
No
If you answered yes to the question above, please list their allergies / sensitivities.
During vet visits my animal companion
Is relaxed and likes to be social
Is nervous but seems to "accept" what has to happen
Is afraid and may try to run away or bark / growl
Is uncomfortable and needs to be muzzled as a precaution
Currently has to be sedated for vet care
Does your animal companion have any current illnesses or injuries?
Yes
No
Does your animal companion have any chronic or reoccurring medical issues?
Yes
No
If you answered "yes" to either question above, please list the specific illness, injury, or medical issue below and include the date(s) this began.
Has your animal companion had any previous illness, injury, or medical issue that required veterinary treatment?
Yes
No
If you answered yes to the question above, please list the specific illness, injury, or medical issue and include the date(s) it began and was resolved.
Has your animal companion had any surgeries besides their spay/neuter?
Yes
No
If you answered yes to the question above, please list the specific surgeries and their dates below.
Has your animal companion ever been assessed for pain, had a pain trial, or had a gait analysis?
Assessed for Pain
Pain Trial
Gait Analysis
None of the above
If you selected any of the answers other than "none" above, please share the details of why you had these assessments done.
Besides their monthly preventative, is your animal companion on any current medications?
Yes
No
If you answered yes, please list ALL current medications and provide the following details: their dosage (amount and frequency) instructions, what they are being given for, and when these medications were first given.
Has you animal companion previously been on medications that are no longer is use?
Yes
No
If you answered yes, please list ALL previous medications and provide the following details: what they were given for, when they were started, when they were discontinued, and why they were discontinued.
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Developmental History
When did your animal companion join your family?
-
Month
-
Day
Year
Date
How old were they when you brought them home?
How did you acquire them?
Shelter / Rescue
Breeder
Private Rehoming from a Friend
Private Rehoming from a Stranger
Other
If your animal companion came from a shelter, rescue, or breeder please provide the name of this individual / organization below.
If you got your dog as a puppy, were you able to visit them before the age of 10 weeks?
Yes
No
Were you able to meet your animal companion's parents?
Yes
No
If you answered yes to either of the question above, please provide details about the environment you met your puppy in, the behavior of your puppy when you met them, and the behavior of their parents if you met them.
If your animal companion was older than 16 weeks (4 months) when you brought them home, were you given any information about their prior life experiences?
Yes
No
If you answered yes to the question above, please provide details about their previous experiences including who provided you with this information.
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Environmental History
How many people live in the home with your animal companion?
Please list all human members of the household with their age.
How many animals live in the home with the animal companion you are seeking assistance for?
Please list all non-human members of the household and indicate their species, age, sex and status, and if they joined the home before or after this individual. (Example: Rocket - Cat, 6yr, Neutered Male, Before.)
Do any of the other animal family members have behaviors of concern including general anxiousness, storm anxiety, over-arousal, reactivity, resource guarding, etc?
Yes
No
If you answered yes to the question above, please provide a brief description of the behaviors of concern. (Example: Banana Bread - Resource Guarding of Food)
If you are seeking assistance for an animal who has negative feelings towards strangers (ex: reactivity, fear) please indicate how many people outside of the household are currently in their "inner circle". (The "inner circle" would be individuals who can come into the home and interact with the individual without any negative response).
Do you have family, friends, or other professionals (such as a dog walker) who assist in caring for your animal companion or watch them while you are out of town?
Yes
No
If you answered yes to the question above, please note these individuals below. (Ex: Susan - Neighbor, Petsits / Sally - Grandma, Visits Often or Petsits / John - Dogwalker)
We live in a:
Apartment / Condo
Manufactured Home
Townhome / Rowhome
Single Family Home
Other
If applicable, we live:
On the 1st Floor
On the 2nd or higher floor
Not Applicable
If applicable, our development includes:
Shared Stairwells
Shared Elevators
We have a:
Fenced in yard (chain link)
Fenced in yard (privacy fence)
Fenced in yard (electric fence)
Non-fenced private yard
Fenced in shared yard / courtyard
Non-fenced shared yard / courtyard
No yard
How long has your animal companion lived at their current residence?
Moved in within the last 3 months
Moved in 3 - 6 months ago
Moved in 6 - 9 months ago
Moved in 9 months - 1 year ago
Moved in over a year ago
Have their been any changes in the household in the last 3 months? (New person or animal living there, construction, death of a family member, person or animal moving out, etc). If so please note what this change was and when it occurred.
I currently feed my animal companion
Dry Food / Kibble
Wet Food
Freeze-Dried or Refrigerated Food
Raw Food
Homemade Food
Please list the Brand and Diet that you feed daily (Ex: Purina ProPlan Sport).
I provide most meals (75%) in:
A bowl
A slow feeder bowl
A puzzle or treat dispensing toy
A lick mat, kong, or snuffle mat
During Training
I Vary it Frequently
Other
They usually eat:
100% of their food right away
100% of their food within a few hours
100% of their food by the end of the day
Between 75% and 100% of their food daily
Between 50% and 100% of their food daily
Less than 50% of their food daily
Their daily intake varies frequently
What do you and your animal companion do for fun on 4 or more days of the week?
Take Walks in the Neighborhood
Take Walks in a local Park / Go Hiking
Have Dedicated Play Time
Go to the Dog Park / Dog Beach / Dog Bar
Go to Doggie Day Care
Have Dedicated Training Time
Give Extra "Enrichment" Items (Ex: Snuffle Mats, Puzzle Toys, Frozen Kong Toys, Bully Sticks, etc given outside of meal time).
Do Extra "Enrichment" Activities (Ex: Go swimming, Play Scent Games, Do Agility Games at Home)
Other
When it comes to play, my animal companion likes:
Tug
Fetch
Hide and Seek
Wand Toys / Flirt Pole
Playing on their own with toys
Wrestling / Chase / Hands on Play
How many times a day do you typically go for a walk with your dog?
How long do these walks typically last?
10 - 15min
15 - 30min
30 - 45min
Other
How much time on the walk does your dog typically spend sniffing, chewing, rolling, and otherwise actively engaging with the environment? (Ex: 50%)
25% or Less
25% - 50%
50% - 75%
75% or More
What tools do you currently use to walk your dog?
A harness
A "no pull" harness
A flat collar
A head collar (ex: gentle leader)
A prong collar (metal or plastic)
A chain collar
An E-Collar (Shock, Vibrate, Noise)
A martingale collar (fabric or chain)
A leash that is 6ft or shorter
A leash that is 7ft or longer
Other
I carry treats on our walks
Yes
No
I feel confident that I can currently safely control my dog on a walk
Yes
No
I have anxiety about walking my dog
Yes
No
What best fits your dog's response when they see a person during their walk?
Glance over but mostly ignore
Pause and watch, sniff the air
Begin to veer towards the person with a loose wagging tail
Immediately rush towards the person and try to drag me to say hello
Begin jumping around at the end of the leash and barking, won't listen to me
Freezes, stares, gets tense
Begins to walk away
Tries to run away or hide
Gets tense, fur stands up, may bark or growl
Lunges at the end of the leash while barking rapidly or deeply
Exhibits the selected behavior but will respond to me using words or treats
Exhibits the selected behavior but will respond to me correcting them
Other
What best fits your dog's response when they see a dog during their walk?
Glance over but mostly ignore
Pause and watch, sniff the air
Only responds if the dog is barking at them or pulling towards them
Begin to veer towards the dog with a loose wagging tail
Immediately rush towards the dog and try to drag me to say hello
Begin jumping around at the end of the leash and barking, won't listen to me
Freezes, stares, gets tense
Begins to walk away
Tries to run away or hide
Gets tense, fur stands up, may bark or growl
Lunges at the end of the leash while barking rapidly or deeply
Exhibits the selected behavior but will respond to me using words or treats
Exhibits the selected behavior but will respond to me correcting them
Other
On walks, my dog has a notable response to
Cars
Bikes / Scooters / Skateboards
Small Animals (Lizards, Squirrels, Cats)
Large Vehicles (Buses, Garbage Trucks)
Sudden Noises
Sudden Movements (A branch falling, A sign moving in the breeze)
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Social History
What best describes your dog's behavior towards other dogs?
They will befriend anyone. They are easygoing during interactions.
They want to be friends with everyone, but can be a bit much when trying to make friends.
They don't seem to care about other dogs. If other dogs come up to them they seem comfortable.
They tend to ignore other dogs, if another dog comes up they may try to get away or make the other dog go away.
They are picky about their friends and take time to decided about other dogs.
They are afraid of other dogs and avoid them or react to them.
I think my dog is aggressive towards other dogs.
I currently or used to take my dog to doggie day care or local dog-centric hangouts
Yes
No
If you answered yes to the question above, please provide the name of the day care, dog park, dog beach, dog bar, etc.
How long has your dog been going here?
How often does your dog go here?
If you discontinued visits, please note why.
If you answered yes to the question above, please select the option that best describes your dog's behavior while at these locations
Social Butterfly - loose and wiggly body, will play with anyone, frequently goes up to other dogs to invite them to play
Hard Player - likes to do lots of running and wrestling, needs breaks or they get too amped up
Selective with Friends - picks and chooses who they will play with, tells some dogs "no"
In and Out - Spends as much of their time with me / doing their own thing as they do interacting with other dogs (around a 50/50 split)
Independent Observer - Spends almost the whole time exploring and interacting with the environment (including other people), rarely or never plays with the other dogs
Wall Flower - Tends to maintain distance from most dogs or stays with me almost the whole time, may come hide with me if they get nervous
Chilly Dog - Likes to join in when others are laying down or sniffing in a group, but not when they're playing hard
Hit and Miss - Likes some dogs, but doesn't like others and may show teeth, have hair stick up, growl, or snap at dogs they don't like
Has your dog ever gotten into an altercation with another dog OUTSIDE of the home?
Yes, but no one was injured
Yes, my dog was injured but did not need medical treatment
Yes, the other dog was injured but did not need medical treatment
Yes, my dog was injured and needed medical treatment
Yes, the other dog was injured and needed medical treatment
Yes, more than once
No
If you answered yes, where did this occur?
If you answered yes, when did this occur?
If you answered yes, please describe the context surrounding the altercation.
If there has been more than one altercation, please use this space to note for each event where, when, and the context.
Has your dog ever gotten into an altercation with another dog WITHIN the home?
Yes, but no one was injured
Yes, they were injured but did not need medical treatment
Yes, the other dog was injured but did not need medical treatment
Yes, they were injured and needed medical treatment
Yes, the other dog was injured and needed medical treatment
Yes, multiple times
No
If you answered yes to the question above, when did the first altercation take place?
Over time the altercations have
Increased in frequency
Decreased in frequency
Remained the same in frequency
Had very variable frequency
Over time the altercations have
Increased in intensity
Decreased in intensity
Remained the same in intensity
Had very variable intensity
Do you feel you can identify the primary trigger(s) causing the altercations?
Yes
No
If you answered yes to the question above, please list the trigger(s).
Please provide details about the altercations that have occurred in the home. As much as possible, include for each: when it occurred, the context around the altercation, and the outcome of the altercation.
What best describes your dog's behavior towards people?
They will befriend anyone. They are loose and easygoing during interactions.
They want to be friends with everyone, but can be a bit much when trying to make friends.
They don't seem to care about people, but if people come up they seem comfortable
They tend to ignore people and if people approach they may try to get away or make the person go away
They are picky about who they let in their circle and may take time to build trust
They are afraid of people and avoid or react to them
I think my dog is aggressive towards people
Does your dog respond differently towards strangers if they encounter them in different places? For example, do they act differently towards a person coming into the home versus a person at the store?
Yes
No
If you answered yes to the question above, where does your dog seem most comfortable?
In the home
Outside the home, in the neighborhood
Outside of the neighborhood
If you answered yes, please note the differences in your dog's behavior between these locations.
Has your dog every displayed rapid deep barking, growling, lunging, or snapping towards a non-family member?
No
Yes, someone they had met more than once
Yes, a stranger
All the time
Over time these behaviors have
Increased in frequency
Decreased in frequency
Remained the same in frequency
Been very varied in frequency
Over time these behaviors have
Increased in intensity
Decreased in intensity
Remained the same in intensity
Been very varied in intensity
Has your dog every bitten a non-family member
No
Yes, someone they had met more than once
Yes, at the vet
Yes, a stranger
It did not break skin
It did not break skin but did bruise
It broke skin but didn't need medical treatment
It required medical treatment
More than once
Do you feel you can identify the trigger(s) that led to these incidents?
Yes
No
Please provide details about each bite including: When it occurred, The context surrounding the bite, the outcome of the bite:
Has your dog ever displayed rapid deep barking, growling, lunging, or snapping towards a member of the family?
Yes
No
Yes, a few times
Yes, often
Over time, these behaviors have:
Increased in frequency
Decreased in frequency
Remained the same in frequency
Had very varied frequency
Over time, these behaviors have:
Increased in intensity
Decreased in intensity
Remained the same in intensity
Had very varied intensity
Has your dog ever bitten a member of the family?
No
Yes, it did not break skin or bruise
Yes, it did not break skin but did bruise
Yes, it broke skin but did not need medical treatment
Yes, it required medical treatment
Yes, more than once
Over time, the bites have:
Increased in frequency
Decreased in frequency
Remained the same in frequency
Been very varied in frequency
Over time the bites have:
Increased in intensity
Decreased in intensity
Remained the same in intensity
Been very varied in intensity
Do you feel you can identify the trigger(s) leading to these incidents?
Yes
No
If you answered yes, please list the trigger(s).
Please provide details about each bite including: When it occurred, The context surrounding the bite, the outcome of the bite
I feel like my dog is unpredictable
Yes
No
In some situations
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Behavioral History
Have there been any instances of urination / defecation in the home since potty training was completed?
Yes
No
If yes, how often does this occur and when did it last occur?
Have there been any instances of destructive behaviors in the home since house training was initially completed?
Yes
No
If yes, how often does this occur and when did it last occur?
If yes, what has been destroyed or chewed on? (Ex: Walls, Floorboards, Blankets, Pillows, Chairs, Remotes).
When we are away from home my animal companion is:
Free roaming in the house
Has part of the house or a specific room
Is secured in a pen or crate
When we are away from home my animal companion seems:
Totally relaxed / unbothered
More sensitive to sounds and sights out the windows, but otherwise normal
Unhappy and usually whines, stares out the window, or lays by the door until we return
Stressed and may chew excessively, drool, whine, or pace.
Anxious and may go potty, chew up things, vocalize, refuse to eat treats we leave out, or hurt themselves.
I have a camera that I use to monitor my animal companion when I am not home
Yes
No
When it comes to the crate, my animal companion
Goes in it all the time on their own for naps and goes right in happily when I ask
Goes into it hesitantly or begrudgingly when asked
Has to be bribed or physically put inside the crate
Will vocalize and try to get out
Has broken out of crates in the past
Other
If I am on the other side of a pen, baby gate, door, window, etc from my animal companion they
Don't care
Will watch me for a bit then do their own thing
Watch me the whole time
Whine, paw at the barrier for a bit
Bark, dig at or try to get over the barrier the whole time
During storms and/or fireworks my animal companion seems
Unbothered / No change
Slightly on edge, may pant or seek comfort from me
Afraid, may drool or pace or hide
Panicked, may destroy things or hurt themselves
When my dog is eating their regular food, if I am nearby or approach them they will:
Have no reaction to me
Pause, freeze, or tense up
Lean their body over their food
Start scarfing their food down
Stare at me with a "hard eye"
Growl
Raise their lip
Snap
Bite
Walk away from their food
If my dog has a high value treat, such as a bone, and I am nearby or approach them they will:
Have no reaction to me
Pick it up and walk away with it
Wrap their paws around it
Put their body on top of it
Pause, freeze, or tense up
Stare at me with a "hard eye"
Growl
Raise their lip
Snap
Bite
Walk away from it
If my dog is laying down with a toy, and I am nearby or approach them they will:
Have no reaction to me
Try to get me to play
Pick it up and walk away
Wrap their paws around it
Put their body on top of it
Pause, freeze, or tense up
Stare at me with a "hard eye"
Growl
Raise their lip
Snap
Bite
Walk away from it
My dog exhibits these behaviors towards other dogs in the home
Never
Over their regular food
Over high value treats
Over toys
In other situations
I feel my dog may demonstrate tense body language, growling, snapping, or biting if:
They are startled awake
I try to clip their nails
I try to brush or bathe them
If I try to take away something they picked up (ex: garbage, a sock)
I scold them
I try to pick them up
I try to get them off the furniture
I try to put on their collar or harness
Other
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Training History
I have tried to teach my dog:
On my own
By taking them to a group class
By having a trainer come to our home
By sending them to stay with a trainer
I have not tried to train my dog
I or a trainer have used these tools while teaching my dog:
Supplements
Medications
Treats
Toys
Praise and Affection
Other Reinforcers
A flat collar
A martingale collar
A choke chain
A prong collar
A head halter
A "no-pull" harness
A "normal" harness
A remote collar that makes a noise, vibrates, or shocks
A slip leash
A leash 6ft or shorter
A leash 10ft or longer
An anti-bark collar or sonic device
A crate, pen, or baby gate
A bed or mat
A "place" bed for a long period of time (greater than 15 minutes)
A spray such as water, air, or citronella
A bonker or shaker can
Verbal corrections such as "no" or "uh uh"
Leash corrections
An electric fence
Yelling
Scolding
Hitting or Swatting Physically
Other
Please list the behaviors you feel your dog currently knows. For example: Sit, Come, Shake, Wait
I feel like my dog:
Loves training! They always seem like they are having fun.
Likes training - sometimes they seem super into it and sometimes they seem disinterested
Isn't a big fan of training, they seem like they would rather do something else
Only does what I ask if I have a treat in my hand
Only does what I ask if I have their collar / leash on
Name of previous professional trainer / name of the business
Start and End date of working with this trainer
What did you ask this trainer to help you with?
Please briefly describe the types of exercises you and this individual did with your dog.
Please briefly describe the outcome of this experience. (Did the behavior get "better" or "worse", did it go away but then come back, etc).
If you worked with more than one trainer previously, please use this space to provide the following information about each trainer: (1) Business Name, (2) Dates that you worked with them, (3) If they came to your home or if your dog stayed with them, (4) any details you feel are important.
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Training Agreement
Media (photos of videos) of my animal companion taken during training can be utilized by the Good Steward Training Company on their social media platforms, website, and in educational or presentational materials.
Yes
No
Non-Staff including mentees and other trainers who adhere to the ethos of The Good Steward Training Company may assist with my dog's training:
Observe
Act as an assistant
Handle my dog directly under supervision and with instruction
None of the above
I understand that The Good Steward Training Company is providing guidance and support in regards to my animal companion's welfare and behavior. While they will be training my animal companion directly, I understand that the progress my animal companion makes is heavily impacted by my cooperation and effort and that the long-term success of my animal companion is contingent upon my continued willingness to provide them the support and guidance as instructed by my behavioral modification coach.
Yes, I understand and agree
No, I do not understand
No, I understand but I do not agree
I acknowledge that behavior is dynamic, learning is always taking place, and the day-to-day choices of my animal companion are influenced by many variables. I understand that, because of the nature of behavior, The Good Steward Training Company cannot make any guarantee regarding the outcome of any modification program. I understand that we may uncover information about my animal companion that requires additional work with a vet or vet behaviorist.
Yes, I understand and agree
No, I do not understand
No, I understand but do not agree
My coach my find it necessary to my animal companion's wellbeing and behavior success that I acquire items such as treats, enrichment puzzles, a muzzle, leashes, harnesses, or medication. I understand that I am responsible for the cost of these items, and that if I decide not to acquire recommended or necessary items it will impact my animal companion's welfare and/or success.
Yes, I understand and agree
No, I don't understand
No, I understand but I don't agree
My dog has exhibited aggression towards people prior to the date this form has been submitted.
Yes
No
My dog has exhibited aggression towards other animals prior to the date this form has been submitted.
Yes
No
Given my dog's history of aggressive behavior, I understand that they are now or may become a risk to the safety of others even with the behavioral support of The Good Steward Training Company. I am electing to seek behavior modification for my dog even though the exact outcome of this program cannot be guaranteed. During and after our work together, The Good Steward Training Company LLC can only be held liable for my dog's behavior during times in which my dog is being handled by or in the direct care of The Good Steward Training Company. I acknowledge that I am solely responsible for any damage my dog inflicts upon an animal or person at any and all other times.
Yes, I understand and agree
No, I do not understand
No, I understand but I do not agree
This does not apply to my dog
I understand that withholding information about my dog's prior behaviors and experiences puts others, including employees of The Good Steward Training Company and members of the public, at risk. I accept complete responsibility and liability for any harm that occurs as a result of lack of disclosure prior to training.
Yes, I understand and agree
No, I don't understand
No, I understand but I do not agree
I understand that the initial consultation will be billed individually and does not promise any further services by The Good Steward Training Company. I acknowledge that The Good Steward Training Company has the right to refuse services to me at any time for any reason not protected under discrimination laws.
Yes, I understand and agree
No, I don't understand
No, I understand but I don't agree
The Good Steward Training Company will always act in good faith. They agree to bring any disputes or concerns to me in a prompt manner. They agree to seek resolution through mediation prior to doing so through litigation. I agree to act in kind - to bring disputes or concerns directly to them in a prompt manner and to seek resolution through mediation before taking legal action.
Yes, I understand and agree
No, I don't understand
No, I understand but I don't agree
The Good Steward Training Company has a professional duty to provide a safe environment for my animal companion during learning. I agree that the Good Steward Training Company is only liable for harm either to or caused by my animal companion in cases where negligence on the part of The Good Steward Training Company can be proven.
Yes, I understand and agree
No, I don't understand
No, I understand but I don't agree
I understand that the terms and conditions set forth in this agreement cannot be modified or changed in any way after I submit this form unless the modification is agreed upon with witnesses and in writing by both parties. I have read and fully agree to all terms and conditions.
Yes, I understand and agree
No, I do not understand
No, I understand but I do not agree
By signing below I, as the legal owner of this animal, certify that everything stated above is accurate and truthful to the best of my knowledge. I herby waive and release The Good Steward Training Company, its owners, and its employees from all liability including but not limited to illness, injury, death, sickness, or damage unless direct and certain neglect or intent is proven. I certify that The Good Steward Training Company is not liable for my pets behavior at any time that my pet is not being handled by an employee and cannot be held responsible for my pets behavior outside of and after training.
Thank you for taking the time to fill out this questionnaire! We are honored by your choice to trust us with your animal companion's welfare and behavioral modification. We look forward to helping you succeed!
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