Dog Behavior History Questionnaire

Dog Behavior Questionnaire
Hello!

Please get comfortable, this'll take a while...

In order for me to get to know you and your dog and understand the issues you're having, please take your time and provide as much detail as possible when filling out this questionnaire.

If something doesn't apply to you, or you've already answered the question, just place a period in the space or write N/A and move on. This applies to all sections.

Lastly, please be honest and accurate in your answers. I promise not to judge you!

Ready? Let's get started...
First Name*
First name
Last Name*
Last name
Email*
example@example.com
Phone Number/WhatsApp*

Country CodeArea CodePhone Number
Address*
Street, Town, State/Country, ZIP code
Would you like to receive updates, training info, newsletters?*

YESNO
Please advise if you have any disability, health or physical issue we should be aware of that would affect your ability to participate in training your dog
Household Members: briefly describe all the members of your household*
i.e. Name, Age, Relationship to you
Who referred you to us/how did you hear about us?*
Dog's Information

IMPORTANT! If you are inquiring about training for more than one dog, please fill out a separate form for each.
Dog's Name*
Dog's Description*
E.g. breed/mix, size, sex, color
Reason for Contacting Me
What made you reach out now?
- New puppy/new dog
- General training and manners
- Problem behaviour - Why now?
- New behaviour
- Recent increase/incident/etc.
- Not resolving, time to get help.
- Situational change
- Other...
Please describe:*
Presenting Problem #1
What is the main reason/problem that you are inquiring about?*
When did you first notice tendencies of this problem behaviour?*
Has there been a recent change in the behaviour? (More frequent? More intense? Different circumstances?) Please describe:*
How often does it occur?*
Can you anticipate when it is likely to happen? (When, where, who is present, trigger, etc.)*
Why do you think your dog is doing this?*
What have you done so far to address this problem? With what effect?*
What would you consider an acceptable goal/outcome of a training program?*
Please describe several recent incidents in as much detail as possible.*
Presenting Problem #2
What is the secondary reason/problem that you are inquiring about?
Background: When did you first notice tendencies of this problem behaviour?
Has there been a recent change in the behaviour? (More frequent? More intense? Different circumstances?)
How often does it occur?
Can you anticipate when it is likely to happen? (When, where, who is present, trigger, etc.)
Why do you think your dog is doing this?
What have you done so far to address this problem? With what effect?
What would you consider an acceptable goal/outcome of a training program?
Please describe several recent incidents in as much detail as possible.
Other Behaviour Problems
Check all that apply and provide details:*

AnxietyAggression to PeopleAggression to DogsAggression to Other AnimalsBarking, vocalizing excessivelyyChasing people or dogsCounter SurfingDemanding, attention seekingDestructive (chewing, scratching, etc.)DiggingDoor dashingEscaping (Fence jumping, etc.)FearHouse soilingIgnoring you, "stubborn"Jumping up on PeopleJumping up on Counters, Tables, etc.Running offResource Guarding (can't take away object, etc.)Separation distressStealing food, objectsUnruly (Jumping, mouthing, etc.)Other: humping, eating non food objects, compulsive behaviour...
Please describe...*
Any particular dog/dog or dog/human dynamics that are relevant to your inquiry?*
Health and Veterinary Information
Veterinary Clinic*
Is your dog up to date on vaccinations and protocols as recommended by your Veterinarian?*

YesNo
Does your dog have any allergies?*

YESNO
Is your dog currently taking any medications or supplements?*

YESNO
Please list what your dog is taking, the reason and dosage:*
Please describe any relevant past or present medical or health conditions (allergies, medication, injury, etc.).*
Have you specifically asked your veterinarian about any of your dog’s training and behaviour concerns? If yes, what was their advice?*
Do we have your permission to contact your veterinarian about your dog’s behaviour or health?*

YESNO
Background Information
What are your reasons for having a dog?*
Where did you get your dog from? Include name of organization/breeder.*
How old was your dog when you got him/her?*
What do you know as fact about your dog’s background?*
What are some of your reasons for choosing this particular dog?*
Household Information
Do you live in*

a housea condoan apartmentother
Do you have a yard?*

YESNO
Is it fenced?*

YESNO
If unfenced, what do you use to contain your dog?*
Is anyone in your household afraid of or dislikes your dog?*
Is there any conflict in the home regarding your dog’s behaviour and training?*
Describe the environment around the home (i.e. rural, urban, quiet, busy, etc.)*
Diet and Feeding
What do you feed your dog? Please be specific (brand, variety, canned, dried, raw, homecooked, etc.). Also, why did you choose this particular food for your dog?*
How food motivated is your dog? 1 - 10 (finicky ... voracious)*
Please describe your dog’s meal time (where, when, how often, who feeds, special routine, etc.):*
Does your dog guard their regular meal against humans (growl, snap, etc.)?*
Please describe any treat routine your dog has. (Who, what kind of treat, etc.)*
Activities
What would your dog say that her/his favorite pastimes are?*
What types of play do you engage in with your dog? Please describe:*
What does your dog get to chew? How Often? *
What types of exercise does your dog get, and how often/how much? (Be honest! ;-) )*
Leash Walks: Please describe: How often? Where? For how long? How does your dog act on leash?*
Walking gear: Please describe, what kind of leash, collar or harness do you use now?*
What other equipment have you tried or used in the past?*
Does your dog get off leash time? Please describe where, when, etc. or why not?*
Does your dog use a muzzle for any reason? Explain.*
Home Alone
How long is your dog left alone on an average day?*
Where does your dog stay when you are not home?*
How does your dog do when left home alone? So so? Totally fine? Anxious/distressed?*
How does your dog react when you leave home and return?*
Is your dog content in a crate? If no, please describe history of exposure*
Home Together
How would you describe your dog's energy/activity level?*
What does your dog do when you are at home and not interacting with them?*
Is your dog allowed on furniture?*

YesNoWith permission
Do you have any special rules and boundaries in your home, yard, etc.?*
Where does your dog rest during the day when you are home?*
Where does your dog sleep at night?*
Is your dog a sound sleeper or easily disturbed? Settles easily? Please describe.*
Meal time: What does your dog do when you have your meals/snacks?*
Visitors
How does your dog react when familiar people come to your home? Please describe: (Bark, jump, mouth, calm, aggressive, nips/bites, hides, etc.)*
How does your dog react when unfamiliar people come to your home? Please describe: (Bark, jump, mouth, calm, aggressive, nips/bites, hides, etc.)*
Vehicles Outings
How often does your dog go with you in the car? Where to?*
Please describe your vehicle, where in the car your dog rides and how (loose, seat belt, crated?) and your dog's behavior in and near the car:*
Grooming and Handling
Which grooming tasks do you perform yourself? List: (Bathing, brushing, trimming, nail clipping, teeth cleaning, ear cleaning, none, other...)*
How does your dog react? Please describe: (Cooperative, shuts down, struggles a bit/a lot, resists certain parts, bites, use a muzzle, etc.)*
Does your dog go to a groomer?*
Elimination
Is your dog fully house trained?*
Does your dog urinate when excited/greeting/stressed, etc? Please describe.*
Any other details about house training?*
Other Activities
Please describe activities you do with your dog in terms of enrichment, games, classes, sports, etc.
Temperament
What do you like about your dog? Name 2 or 3 qualities...
What do you find most annoying about your dog? Yes, you can mention that; Name 2 or 3...*
Training
What are your 3 main goals regarding your dog's behavior?*
What are some specific training goals that you would like to work towards?*
What are some of your training successes? (Tricks count!)*
What are some of your training challenges?*
How do you let your dog know when they have done something “good”?*
What are some of your dog’s favourite rewards? Be specific.*
How do you let your dog know when they have done something “bad”?*
What types of corrections have you tried or currently use? *
With what effect? (ie: no change, stopped behaviour, got worse, only worked with certain person, etc.)*
Have you previously employed the services of a trainer/dog behavior consultant/vet behaviorist for this dog? If yes, please describe who you went to, what was worked on/taught, etc.*
What type of methods were used?*
How was your experience and the results?*
Have you employed the services of a trainer/dog behavior consultant with a *previous* dog? Please describe what for, what was done, results, etc.*
Does your dog attend doggie day care, dog walker or a boarding facility?*
Does your dog regularly attend “Dog Parks”? If yes, please describe: park type, dog interactions, your dog’s behaviour, etc.*
Almost Done!
Is there anything else that you would like me to know about your situation or your dog?*
Please choose the option most appropriate for you (scroll down to see all 6 options):*

I would like to learn more but the prblem is not seriousI would like to change the problem but it is not seriousThe problem is serious and I would like to change it; but if it remains unchanged that's alrightThe problem is very serious and I would like to change it, but if it remains unchanged I will keep my dogThe problem is very serious and I would like to change it. If it remains unchanged I will have my dog euthanized or give him/her upI have almost given up already and am seriously considering having my dog euthanized or giving him/her up
How much time per day total are you able to dedicate to training? (in 10-minute increments. ie: total 1 hour)*
Thank you for taking the time to complete this form. Consider recording any incidents in chronological order and share it with me before or on the day of our next session. Also, please record any new incidents or issues as they come up.

What happens next: I will review the information you submitted and then contact you to confirm receipt and book/confirm your appointment, generally within 1-2 business days. If you do not hear from me after 2 business days, please send a text message to make sure it was received.

As always you can reach me by phone or text at 804-904-9921 or via email at noaligh@gmail.com

The information contained in this form will not be shared with anyone outside of Holistic Spirit Dog Training without your express, written, permission.

I look forward to helping you and your dog live more joyfully together!
Should be Empty:

Dog Behavior Questionnaire

Dog's Information

Reason for Contacting Me

Presenting Problem #1

Presenting Problem #2

Other Behaviour Problems

Health and Veterinary Information

Background Information

Household Information

Diet and Feeding

Activities

Home Alone

Home Together

Visitors

Vehicles Outings

Grooming and Handling

Elimination

Other Activities

Temperament

Training

Almost Done!