Behavior_Helpline_-

- Name*
  
  First NameLast Name
- Mailing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone number*
- Email address*
- What is your neighborhood setting like?
  
  RuralSuburbanUrban
- Do you have a fenced yard? If so, what type of fencing and approximate size?
- Are there dogs in the neighboring yards?
- How did you hear about Aska's Animals?*
  
  Adopted from Animal Adoption CenterContacting or visiting Animal Adoption CenterAnother shelter/rescueVeterinarianWebsite/Online SearchFriend/Family MemberFacebookInstagramNewspaperOther
- Dog's name*
- Age*
- Gender*
  
  Intact femaleIntact maleSpayed femaleNeutered male
- Breed(s) or best guess*
- Where did you get your dog?*
- Why did you choose this particular dog?
- What is your dog's history prior to adoption, if known?*
- How long have you had your dog?*
- What are three of your favorite things about your dog?
- Who is your veterinarian?*
- Does your dog have any medical issues, including allergies? If so, please describe.*
- If your dog is taking any medication, please list the drug and dosage*
- What brand of food do you feed?*
- How many cups of food do you feed each day?*
- What is your dog's feeding schedule? Check all that apply*
  
  Food is available all/most of the timeScheduled MealsMy dog eats immediately and finishes her foodMy dog is a picky eater and takes her time or grazes
- What are your dog's favorite treats or snacks?*
- What are your dog's favorite toys or games? (ex. fetching ball, frisbee, tug of war, etc.)*
- Has your dog received any formal training? If so, please list the trainers/organizations you've worked with*
- Do you have any previous training or behavior experience?
- Please check all the equipment you've used with your dog*
  
  Flat collarHarness-front or back clipHead halter - gentle leader, etc.Choke chain/training collarPinch/prong collarBark collarElectric collarInvisible fenceCrateExercise penBaby gateTether (for time outside)Long lineThundershirtOther calming products (aromatherapy, collars, herbs, etc.)
- Describe your dog's exercise routine (activity, distance/duration, frequency, locations, plus nap/down time and durations, etc.)*
- Where does your dog sleep at night?*
- What is your typical schedule for work or school?*
- Where is your dog when left alone?*
- How often is your dog left alone?*
- How does your dog do left alone?
- Does your dog show any of the following when left alone?
  
  shakingexcessive salvationpacingwhiningbarkinghowlingscratching at doorsnone of the aboveOther
- Would your dog be comfortable and relaxed confined (behind a baby gate, or in a crate) if you were home in another room?
- If there are other people in your household, list them below (please include ages of children)*
- Do you have frequent visitors to the home?
- How would you describe your household? Quiet and calm, bustling and noisy, or in between?
- Describe your dog's behavior and relationship(s) with human family members*
- If you have other pets in your household, please describe them below (species, breed, age, gender, spayed/neutered, etc.)*
- Describe your dog's behavior with other pets in the household.*
- How does your dog react when strangers come to the door?*
- How does your dog react after guests enter your home?*
- What does your dog do if an unfamiliar dog comes into the house?
- What does your dog do when approached by an unfamiliar person on a walk?
- What would your dog do if someone unfamiliar tried to touch him?
- What does your dog do when approached by an unfamiliar dog on a walk?
- What does your dog do if a person or dog passes by the windows at the front of the house?
- What does your dog do if a person or dog walked by the parked car he was in?
- What does your dog do if you approach his food bowl while he is eating?
- What does your dog do if you approach him when he has a beloved toy, bully stick, or raw bone?
- What does your dog do if you try to take food, bones, or toys away from him?
- What does your dog do when bathed or brushed, has his toenails cut, or gets toweled off?
- What does your dog do when handled by the vet?
- What does your dog do in response to a sudden loud sound?
- Is your dog bothered by thunderstorms, gunshots, fireworks, or any other sounds?
- Does your dog tend to follow family member(s) around?
- Does your dog nudge, nuzzle, or paw for attention?
- What does your dog do if another dog approaches when you are giving attention?
- Given the opportunity would your dog chase a cat and/or wildlife?
- How does your dog behave around unfamiliar objects?
- On a scale of 1-5, 1 being calmest, how excited does your dog get when family members come home:
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Calm, 5 is Excited
- On a scale of 1-5, 1 being calmest, how excited does your dog get when playing:
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Calm, 5 is Excited
- On a scale of 1-5, 1 being calmest, how excited does your dog get when doorbell rings:
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Calm, 5 is Excited
- On a scale of 1-5, 1 being calmest, how excited does your dog get when just before a walk or ride in the car:
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Calm, 5 is Excited
- On a scale of 1-5, 1 being calmest, how excited does your dog get when visitors arrive:
  
  1
  
  2
  
  3
  
  4
  
  5
  
  1 is Calm, 5 is Excited
- Are there any other typical situations in which your dog will bark/lunge/growl/overreact that were not mentioned above?
- Does your dog:
  
  chase shadows or reflectionschase his taillick or chew excessivelyNone of the above
- Describe your dog's concerning behavior. Please be as detailed as possible (where it happens, how often, specific details, etc.)*
- When did this behavior start?*
- Were there any environmental or lifestyle changes that occurred around the time your dog's behavior changed? If so, please describe. (ex. moved, had baby, different roommates, job schedule change, etc.)*
- What do you do when your dog exhibits this behavior?*
- How does your dog react to your response?*
- What changes (if any) have you made due to your dog's behavior?*
- Have you consulted anyone else about this behavior? If so, what was the result?*
- Has your dog ever bitten or injured a person? If so, provide details including circumstances leading to the incident, nature of injury, and level of medical attention needed.*
- Has your dog ever bitten or injured another animal? If so, provide details including circumstances leading to the incident, nature of injury, and level of medical attention needed.*
- Are you considering re-homing your dog?*
- What days of the week are you most likely available to meet? Weekends/weekdays?
- Is your annual income greater than $50,000?
  
  YesNo
- ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY
  
  PLEASE READ AND SIGN BELOW
  
  I fully understand and agree to assume all risks involved in any activities that I take part in at Aska's Animals Foundation (AAF) and I agree to hold the AAF harmless for any injury(s), which I might sustain during the course of my interactions with the AAF.
  
  This waiver does include myself, all of my family members and descendents forever from seeking any legal action whatsoever against the AAF or its representatives.
- Signature
- Should be Empty: