K-9 Coach Behavior Fact Sheet
Contact Info
Let us know how to get in touch with you!
Owner Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
About your dog
Tell us about your pup!
Dog's Name
Breed
Approximate Age
Sex
Male
Female
Spayed/Neutered
Yes
No
Behavioral Changes
Yes
No
Where did you get your dog?
At what age?
Do you know if the dog's parents or siblings engaged in similar behaviors or in any other abnormal behaviors? (If yes, please explain)
List other animals in the household, their species, breed, age sex and whether or not they are neutered, please indicate which of these animals were living in the house when this dog was acquired question
Describe interactions between the animals in the household
Describe interactions between the dog and family members
How does the dog react to strangers?
Does the dog live primarily inside or outside?
Describe any restrictions to dog's movements inside the house/kennel/etc.
Dog's Medical History
Veterinarian
Last Vet Visit
-
Month
-
Day
Year
Date
Medical Problems
Medications
Behavioral Information
What behaviors/factors led you to seek training? (check all that apply)
Aggressiveness
Fear
Separation Anxiety
Other
If applicable, please describe your dog’s specific behavior issue(s)
Age of onset
Duration of each incident
Frequency of occurrence
Have there been any changes in the pattern, frequency, intensity and/or length of incidents from the time of onset to the present?
Are there any specific conditions which seem to trigger the behavior?
Can the dog be interrupted when engaged in the behavior?
How long is the interval between the behavior stopping and the beginning of the next occurrence?
Describe any methods used to stop the behavior and the dog's response to these methods
Please give a detailed description of the last time this problem occurred
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