LLW QUESTIONNAIRE

LOOSE LEASH WALKING QUESTIONNAIRE
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email
example@example.com
K9 COMPANION INFORMATION
Name
Breed
Gender

Female/Intact Female/Spayed Male/ Intact Male/ Neutered
Age
Approximate weight
How long have you had this dog?
What type of food does your dog eat?
Any known food allergies?
Training History
What training have you done with this dog? (List behaviors, skills, other)
Who did the training? And what methods were used?
What do you know about positive reinforcement training?

Antecedent Arrangement Use of clicker or other marker Luring Shaping
Question specific to leash walks
What type of equipment do you use to leash walk your dog?

Regular collar Martinagale collar Prong collar Choker collar Harness
What length of a leash do you use to walk your dog?
Where do you usually leash walk your dog? How busy is that area?
Are you willing to drive to a location to walk your dog other than your neighborhood?

Yes No Maybe
Do you usually walk your dog by yourself, or do you walk with a human partner?
Is your dog currently pulling on leash?
If you answered 'yes' to the last question please fill the next section
Are there specific times, locations or situations where most of the pulling occurs?
Does your dog pull towards something specific? Describe
When pulling does your dog also?

Barks Whines Growls Other
What have you tried so far to reduce the pulling?
Medical History
How is your dog’s veterinarian (clinic name and location)
Date of last rabies vaccination:
Does your dog have any medical or physical issues? Please describe:

LOOSE LEASH WALKING QUESTIONNAIRE

K9 COMPANION INFORMATION

Training History

Question specific to leash walks

If you answered 'yes' to the last question please fill the next section

Medical History

HOUSE HOLD AND GENERAL INFORMATION

The initial session