Pawsitive Behavior Questionnaire

Initial Assessment Form

Please submit it prior your scheduled in home or virtual assessment
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Dog's Name*
Breed*
Dog Age*
Background
How long have you had your dog?
My dog is contained in yard by

chain link fenceunderground fencingtied outkennelon leashnot contained at all
Tell me about any background you have on your dog prior you brought him/her home.
Why did you choose this particular dog?
Physical and Medical Issues
Vet's Name
If You have your own www.com
Vets's Phone

Area CodePhone Number
Is your dog spayed/neutered?

YesNo
When was last vaccination & wellness exam?
List any current or past medical problems, allergies, & current medications your dog is on.
Training
Has your dog had any previous training? (describe familiar cues, training methods and tools, and who did the training)
Describe how you reward your dog for good behavior.
Describe what you do with your dog's for unwanted behavior, and give an example of the circumstances under which you might do so.
Who does or is responsible for training your dog in your family setting?
Describe your training goals for your dog.
What type of exercise does your dog receive & how often?
Describe how you play with your dog, for how long and how often.
Is your dog food motivated?
What is your dog's favorite treat?
Is your dog toy motivated?
What is your dog's favorite toy/activity?
What behaviors would you like to change?

Jumping on peopleExcessive chewingOut of control barkingProblems housetrainingChasingNippingCounter surfingNot coming when calledRunning awayDoes not listenProblems crate trainingPulling on walksStealingNippingDiggingPlaying roughBegging at tableGets on furnitureOther
Behavior Issues
Under what specific circumstances does the behavior(s) occur?
Has the frequency of the behavior

IncreasedDecreasedRemained the same
Has the intensity of the behavior(s)

IncreasedDecreasedRemained the same
Handling Issues
At vet or groomer

growls no bitelungesno growl, will bitebite has broken skinhas to be muzzlednot a problem
Activities you or family members cannot do

Pat top of headReach for dogLean over dogStep on dogPick up dogPush off couch or bedBathe dogBrush dogPull fur including tailCheck teethCheck/clean earsclip nailsgrab or pull on collarattach leash to collarhugrestrainno problem
My dog is less accepting of touch on

feetfaceearstailmouth
My dog's reaction is

pulls awaygrowlssnarlswarning nipsserious bite
Resource Guarding Issues
What items does your dog guard

food bowltoystreatsbones/rawhidesalll possessionsme or family membernot a problem
My dog's reaction is

runs away with itemgrowlsshows teethwarning nipsserious bite
This behavior started when

young puppy5 month or olderadultjust started recently
This behavior is more intense

feeding areaon couchin crateunder tableback yardother
When your dog has a valued item, what is his reaction if someone approaches?

stiffening of bodyfreezesstaresgrowlsair snappinglungesserious biteruns awaywill drop/give eventuallynot a problem
How long has your dog be guarding?

since a puppywhen 5 months or olderjust started recently
What have you done to address this issue so far? Please be specific.
Reactivity to People
What is your dog's reaction to strangers?

barkshair raises on backgrowlssnarlslunges at personstares at personbacks upair snappinghides behind youruns away & hidesnot a problem
My dog has this reaction when

someone comes in yard/housemeeting on walksdoorbell or knock on doorpeople walking past yard/houseonly when person enters houseperson goes to petperson turns & walks awayother
My dog does not like

kidsteenagersmenwomenelderlyhatssunglassespurses/packagesfacial hairbeing pettedgesturingfast movementscoming toward himfamily member
This behavior has become

more frequentmore intensestayed the same
In detail, what has been done to address the issue so far? Describe results.
Describe in detail circumstance of bite. Who, when, where, how, seriousness of bite.
Do you take your dog places? Describe where, why, how often, and how does your dog behave in those places.
Home Environment
Which describes your home environment best? Mark all that apply

CalmPredictableBusyHecticLoud / Chaotic
How many people in your household?
How would you describe your level of engagement with your dog when you home?
Is everyone in the household equally engaged with the dog on his upkeep and training?
Do you have data on what your dog does and how he behaves when you're not at home? E.g video footage from security camera.

YesNo
If not, please describe your dog's overall demeanor when you come home.
Where does your dog sleep?
Do you feed him food scraps? If yes, how often?
Reactivity to Other Dogs
What is your dog's reaction to another dog?

barkshair raises on backgrowlsshows teethlunges at dogstares at dogbacks upstiffening of bodyhides behind youruns away & hidesnot a problem
My dog has this reaction when

other dog comes in yard/housemeeting other dog on walksat the dog parkother dog walking past yard/houseonly with certain dogsother dog turns & walks awayon leashoff leash
This behavior has become

more frequentmore intensestayed the same
This behavior started when

young puppy5 month or olderadultjust started recently
In detail, what has been done to address the issue so far? Describe results.
Has your dog been around other dogs and other species? Describe your dog's demeanor when around them.
If your dog has attacked another dog, please describe in detail the circumstances of the fight.
Should be Empty:

Initial Assessment Form

Reactivity to People

Home Environment

Reactivity to Other Dogs