behavior history

Name

First Name Last Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Is it OK to text this number?

yes no

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What is your pet's name?

What is the main behavior problem or complaint?

How frequently does the main problem behavior occur? Multiple times per day, once or twice per day, weekly, monthly, or irregularly?

When did it first become a serious concern?

In what general circumstances does your dog display the main behavior problem?

Has this main behavior changed in frequency since it started? If so, please describe?

Has this main problem changed in intensity since it started? If so, please describe.

Has this problem otherwise changed? If so, please describe.

Please describe the last 3 incidents of the main problem behavior.

1. Most recent incident:

Date

Description of the incident, including who was present, and what happened immediately before, during, and after the incident.

2. Second to last incident: Date

Date

Description of the incident, including who was present, and what happened immediately before, during, and after the incident.

3. Third to last incident: Date

Date

Description of the incident, including who was present, and what happened immediately before, during, and after the incident.

Describe any other significant incidents of the main problem behavior.

What have you done so far to try to correct the main behavior problem, and what were the results?

Additional Problem #1 if applicable

When did the second problem become a serious concern?

How frequently does this second problem occur?

In what circumstances does your dog display this second problem behavior?

Has the second behavior problem changed in frequency since it started? If so, please describe.

Has the second behavior problem changed in intensity since it first started? If so, please describe.

Has the second behavior problem otherwise changed since it started? If so, please describe.

Please describe the last 3 incidents of that your dog showed the second behavior problem.

1. Most recent incident: Date

Date

Description of the incident, including who was present, and what happened immediately before, during, and after the incident.

2. Second to last incident: Date

Date

Description of the incident, including who was present, and what happened immediately before, during, and after the incident.

3. Third to last incident: Date

Date

Description of the incident, including who was present, and what happened immediately before, during, and after the incident.

Describe any other significant incidents of the second behavior problem.

What have you done so far to try to correct the second behavior problem, and what are the results?

Household Information

Please list the names of all people living in or frequently visiting your home. Include the ages of people under 18, and the average time spent in the home on a daily basis.

Please list all the pets in the home, including this pet, in the order they became part of your family. Include their species, breed if applicable/known, sex, if they are spayed or neutered, the age at which they were obtained, and the age they are now.

Name Species Breed sex, S/N? Age Obtained Age Now

Describe this dog's relationship with each person in the home.

Describe this dog's relationship with each of the other pets in your home.

Have you moved since you acquired this dog?

If yes, when was the most recent move?

Has your household changed since acquiring this pet? If yes, please describe.

About this dog

Why did you decide to get a dog?

Why did you choose this breed, if applicable?

Where was this dog obtained? Breeder, rescue, stray, friend or relative, etc?

Why did you choose or decide to keep this particular dog?

If you know anything about where your dog came from such as their parents, litter mates, previous owner(s), what the rescue said, why the previous owners gave him/her up, anything at all about the history prior to him/her joining your family, please describe it here. If you know the parents or littermates of this dog, please describe their personalities as well.

Please describe your dog's feeding schedule: who feeds your dog, what they eat and how much, favorite treats, where your dog is fed, etc.

Has your dog's appetite recently changed? If yes please briefly describe.

Please describe a typical day in the life of your dog.

How does your dog behave with familiar (adult and children) visitors?

How does your dog behave with unfamiliar (adult and children) visitors?

How do you exercise your dog?

Is your dog ever allowed to run free?

Is your dog ever tied up outside? If so for how long each day?

How do you play with your dog?

How was your dog house trained, if applicable?

Does your dog urinate or defecate in the house?

No Urinates in the house Defecates in the house Both urinates and defecates in the house

If you answered anything other than "no" above, please describe the circumstances and frequency in which your dog urinates or defecates in the house.

Where does your dog sleep at night? Please be specific.

Have your dog's sleeping habits changed recently? If yes, please explain.

When you are not home, where does your dog stay? Describe all the areas inside and out that your dog has access to when nobody is home.

Where does your dog stay when you have guests?

How does your dog behave when you are getting ready to leave the home? If s/he behaves differently based on who is leaving, who is staying, or anything else (suitcases for example), please describe.

How does your dog behave when you return to the home? Does his/her behavior change based on the circumstances? Please describe.

What basic training has your dog had?

None Trained at home by me or family member Trained at home by a professional trainer Trained at a group class with a family member outside the home Board and train facility Private training with a family member outside the home Other

If trained by a family member, who was the primary trainer?

Has your dog had any other training, such as agility, personal protection, advanced obedience, etc.? If yes please describe.

Does your dog know any tricks?

No Yes

If yes, tell us about your dog's tricks!

Have you exhibited your dog at a breed show?

No Yes Not yet, but I plan to

Does your dog jump up on you or others without permission?

No Yes

If yes, what are the circumstances in which your dog jumps on people? Who does your dog jump on?

Does your dog paw at you or others?

No Yes

If yes, describe the situations and who your dog paws

Does your dog lick people without permission?

No Yes

If yes, describe when and who your dog licks.

Does your dog mount people?

No Yes

If yes, who does your dog mount and in what circumstances?

Does your dog mount other animals or objects?

No Yes

If yes, who or what does your dog mount?

Does your dog ever bark at you?

No Yes

Please describe the situations in which your dog barks at you.

Does your dog bark at other times, not at you?

No Yes

When else does your dog bark? Are any of these situations problematic for you?

What is your dog's activity level in general?

low average high excessive Other

Getting pet