Satellite Training/Behavior Intake Form 1 of 2

DogBehaviorRx Assessment Profile FULL

Thank you for booking an appointment and/or workshop with DogBehaviorRx.
As you complete this form, please take your time and be thorough. Some topics may be difficult but honesty and candor are crucial. We are experienced with basic and extreme behavior of all kinds, and exercise discretion with compassion.

Thank you for trusting us with your relationship with your dog. We consider it an honor.

Cristine Dahl

Founder, Northwest Canine
Your Full Name*
Dog's Name*
Best email address for us to use to contact you.*
Best phone number to use to contact you.*

Area CodePhone Number
Where is your dog currently seen for veterinary care, and if you have a preferred doctor, what is his/her name?*
Dog Breed*
Dog Age*
Dog's Weight in Pounds.*
Please note that, for the safety of attendees and staff, dogs over 70lbs are ineligible for participation in SESSION II hands-on appointments. However, owners of dogs over this limit can still participate in all other activities and benefits, including attending SESSION II without a dog.
Is your dog male or female?*

MaleFemale
Is your dog spayed or neutered?*

YesNo
When and from where did you acquire your dog?*
Does your dog have any dietary restrictions? If so, what are they?*
Does your dog display aggressively around other dogs and/or people? (this may be reactivity)*

YesNo
If you answered YES to the question above, please briefly explain what it looks like when it happens.
Has your dog bitten a person or another dog?*

YesNo
If you answered YES to the question above, please explain.
Does your dog suffer any chronic pain that you know of? If so, what is it?*
Please provide a somewhat brief/casual description of your dog as his owner/partner. Please include any information you feel we should know.*
Is there anything else at all you'd like us to know before we meet?
Now Let's Get a Little More Info About Your Dog

This section helps us understand your dog and his/her family dynamic. Please do NOT OVERTHINK this part, spending no more than 5 minutes total. This info is vital for your experience in the class as well as our ability to provide you with a thorough and complete individual assessment and plan.
Please place a check next to ALL traits you'd use to describe your dog's overall personality if you were describing him/her to a stranger.*

confidentpushyindependenthappyaloofdefiantmellowoutgoinglikes most/all peoplelikes dogschilldoes what he wantsunflappableeasygoingboldfearlessdominantassertiveignores medoesn't listeninconsistent response to obedience cuescontentunaware of meresiliantstubbornunpredictableshyanxiousrestlessstand-offishreservedneedytimidreluctanttensereactivehypervigilantskittishunsurefearfulnervousobedientselectively likes peoplesubmissivedepressedclingysensitiveaggressiveunderconfident
For the behaviors below, please indicate the number of times over the period of ONE WEEK you see each.

For this section, please think of your dog in both crisis (when he's upset such as during reactivity or aggression) and non-crisis events. Please remember not to overthink this. We want the general picture of your dog over the period of one week in his/her usual environment.
humps dogs
humps people
resists being physically moved
resists touch/grooming (nails for eg.)
growls toward family member
freezes around family member
hunkers around family member
snarl/snap around family member
sits for treats/food if not asked
uses nose or paw to demand touch or resource such as food or toy
demand barks
direct eye contact
hides
shakes/trembles
drools when food *not* present
gulps
big yawns
guilty look
follows human without being asked
reactive to dogs
reactive to people
paces
ears flat
head held low
tail between legs
barks at delivery person
exposes belly to human
submissive urination
exposes belly (not to dogs or human)
rolls on back to other dogs
shows submissive smile
whines/whimpers
tiptoes ("sneaks")
We'd love to have a picture of your puppy/dog to associate with your file, and to prepare for our meeting. Upload here! (optional)

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Photo 2 (optional)

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After clicking the "submit" button below, you will be provided a confirmation email to the address used above. Please make sure your email settings allow for mail from nwcanine.com and nwcaninestudies.com. If you have any questions or concerns prior to then, don't hesitate to contact via the website. Thank you again for trusting us to be a part of the relationship between your dog and his family. We look forward to working together.
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DogBehaviorRx Assessment Profile FULL

Now Let's Get a Little More Info About Your Dog

For the behaviors below, please indicate the number of times over the period of ONE WEEK you see each.