Dog Behavior Questionnaire
Basic Information
Basic Information
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referred By (Vet, Friend, Trainer)
END
Veterinarian Information
Veterinarian Clinic
Veterinarian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Veterinarian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Upload a Copy of Vet Records (Bloodwork, Labs, ETC.)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
END
Pet Data
Pet Data
Pet Information of Pet's Needing Training
*
Reason(s) For Consult
*
END
Background Information
Backgroun Information
What Do You Believe Has Caused The Problem(s)?
*
Put Pet's Name Then Cause(s)
Describe The Problem - Last Incident: (Make Sure to Include Such Descriptions (If Possible) of The Dog's Body Posture, Locations of Other People or Animals in The Vicinity, Circumstances That You Believe Stimulated The problem, Etc)
*
Describe Any Previous Incidents:
What Has Been Done So Far to Try and Correct The Problem? What Was The Dogs' Response to This?
Has Anything Been Successful? If So, What?
List Anything That Has Made The Problem Worse:
List Any Medications Used Currently or in The Past:
Does Your Pet(s) Have Any Allergies? (Food, Medication, Environmental)
List Any Other Supplements, Vitamins, Dietary Treatments, and Their Purpose:
END
Family Information
Family Information
List Each Family Member Living in The Home
*
How Does Each Pet Get Along With Each Family Member?
Who Feeds and What is The Feeding Schedule?
Who Gives Treats? (How Often, Amount, Type)
Who Plays and What Type of Play?
Who Grooms and How Does Your Pet Tolerate the Grooming?
Who Trains? What Does Training Consist Of?
Who Exercises? What Does Exercise Consist Of and How Long?
Additional Pets
*
How Does Each Pet Get Along?
END
Previous Training
Previous Training
Has There Been Any Formal Training Previously?
Yes
No
What Kind Of Training Previously?
Private In-Home
Private Out-of-Home
Group Classes
Board and Train
If There Was Training, What Company Was The Training With and the Name of Your Past Trainer(s). How Successful Was Training? What Did The Training Consist Of? What Commands Were Taught? What Behavior Problems Were Worked On?
What Collar(s) Were Used For Training?
Flat Collar
Harness
Head Halter
Choke Collar
Prong/Pinch Collar
Martingale Collar
Remote Collar (Electronic)
Remote Collar (Vibrate)
Remote Collar (Tone)
Other
Describe The Response To Any Training Tools:
Are There Any Commands or Tricks Your Dog Knows? What Are They and How Reliable Are They The First Time Asked?
END
Handling
Handling
Does Your Dog React Negatively To Any Types Of Handling?
Nail Trimming
Brushing
Bathing
Rubbing Belly
Grabbing Collar or Neck
Rolling Over
Giving Pills
Hugging/Kissing
Petting Head
Lifting
Other
Describe How Your Dog Reacts to Anything Marked Above:
END
Medical Screening
Medical Screening
Are There Any Past Injuries/Illnesses/Surgeries? Please List:
Does Your Dog Have Any Painful Conditions? Please List and Describe:
What Kind of Diet is Your Dog On?
Dry
Canned
Raw
Home Cooked
Mixture
What Kind Of Appetite Does Your Dog Have?
Normal
Voracious
Finicky
Describe Your Dog's Stool
*
What Are Your Pets' Favorite Treats? List Top 5:
*
END
House-Training Screening
House-Training Screening
Was Your Pet Ever Completely House-Trained?
Please Select
Yes
No
If No, Please List The Pets Not Completely House-Trained:
How Often Does Your Dog House-Soil?
Urine, Stool or Both?
Do You Have a Doggie Door?
Please Select
Yes
No
Had one in the past.
Is Your Dog Ever Crated?
Please Select
Yes
No
Does Your Dog Ever Soil Their Crate?
Please Select
Yes
No
Does Your Dog Leak Urine When:
Sleeping
Walking
Approached By Owner
Approached By Stranger
Excited
Frightened
END
Separation Anxiety Screening
Separation Anxiety Screening
Does Your Dog Display Separation Anxiety?
Please Select
Yes
No
Please Describe Your Dogs' Behavior When Left Alone
Score Your Dog's Separation Anxiety 1-10
END
Fears And Phobias Screening
Fears And Phobias Screening
List Any Triggers That Cause Your Dog Anxiety/Fears/Phobias (People, Dogs, Loud Noises, Objects, Stairs, Vacuum, Children, ETC)
END
Aggression Screening
Aggression Screening
Has Your Dog Ever:
*
Growled
Attempted to Bite
Bitten
Displayed Threatening Behavior
None of the Above
Situations That Caused Aggression
Petting/Handling
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Eating or Being Approached While Eating
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Attempting To Take Food While Eating
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Chewing Stolen Objects/Toys
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Attempting to Take Away Stolen Objects/Toys
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Trimming Nails/Bathing/Brushing
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Staring At Dog
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Scolding Dog
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Leash Or Collar Correction
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Physically Reprimanding Dog
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Raising Hand Over Dog
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Bending Over Or Leaning Over Dog
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Hugging or Kissing Dog
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Grabbing Collar
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Rolling Your Dog Over
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Disturbing While Sleeping
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
While Dog Is On Furniture or Bed
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
Attempting To Remove Dog From Furniture or Bed
Growled
Attempted to Bite
Bitten
Threatening Displays
No Reaction
Which Dog? Please Describe
END
Aggression Towards People (Skip If Your Dog Is NOT Aggressive Towards People)
Aggression Towards People (Skip This Section If Your Dog Is Not Aggressive Towards People)
Does Your Dog:
Try To Attack From A Distance
Investigate The Person Before Attacking
Bark/Growl Before Attacking
Does Not Bark Or Growl Before Attacking
Bite Once And Retreat
Bite Multiple Times And Retreat
Bite And Does Not Let Go
Which Dog? Please Describe
What is The Potential For Injury To A Person? Describe:
Has Your Dog Ever Bitten Hard Enough To Break Skin or Cause Injury?
Please Select
Yes
No
Which Dog? Please Describe
Number Of Bites That Have Broken Skin
Total Number Of Bites
Body Parts Typically Bitten
Has Your Dog Ever Bitten or Been Aggressive Towards An Immediate Family-Member?
Please Select
Yes
No
Which Dog? Describe:
Is Your Dog Ever Aggressive Towards Strangers?
Please Select
Yes
No
Which Dog? Describe:
Is There A Particular Person Or Type (Age, Sex, Build, Uniforms, Clothing Or Apparel) That Your Dog Is Most Likely To Threaten Or Bite? Describe:
Is There A Particular Location Or Situation Where Aggression Is Most Likely To Occur? Describe:
What Is The Usual Distance Away From A Person When Attempting To Attack? Describe:
When Your Dog Threatens, Attempts To Bite, Or Bites, How Do You Handle The Situation And What Is The Dogs Reaction? Describe:
How Would You Describe Your Dog's Attitude At The Time Of Aggression? (Bold, Protective, Fearful, etc)
How Would You Describe Your Dog's Expression And Postures At The Time Of Aggression? (Hackles Raised, Ears Forward or Ears Back, Tail Up, Tail Down Or Tucked Between Legs and Under, Cowering, Running Forward, Running Forward And Then Retreating) Describe:
END
Aggression Towards Other Dogs (Skip If Your Dog Is NOT Aggressive Towards Other Dogs)
Aggression Towards Other Dogs (If Your Dog Is Not Aggressive Towards Other Dogs, Skip This Section
Does Your Dog
Try To Attack From A Distance
Investigates The Other Dog Before Attacking
Bark/Growl Before Attacking
Does Not Bark Or Growl Before Attacking
Attacks Only Bigger Dogs
Attacks Only Smaller Dogs
Size Of Dog Does Not Matter
Attacks Only Female Dogs
Attacks Only Male Dogs
Gender Of Dog Does Not Matter
Bite Once And Retreat
Bite Multiple Times And Retreat
Bite And Does Not Let Go
Which Dog? Describe:
What is The Potential For Injury To Another Dog? Describe:
Has Your Dog Ever Bitten Another Dog Hard Enough To Require Medical Attention?
Total Number Of Bites
Body Parts Typically Bitten
Is There A Particular Location Or Situation Where Aggression Is Most Likely To Occur? Describe:
What Is The Usual Distance Away From Another Dog When Attempting To Attack? Describe:
END
Additional Problems And Goals
Additional Behavior Problems
Do You Have Any Issues With The Following?
Destructive Chewing
Barking
Whining
House-Soiling
Stool Eating
Hunting/Predation
Jumping Up (People)
Garbage Raiding
Food Stealing
Counter Surfing
Stealing Personal Items
Hoarding items
Pushy-Wants Their Own Way
Only Listens When They Feel Like It
Masturbation
Mounting/Humping
Urine Marking
Fence Jumping
Door Dashing
Runs Away
Roaming To Mate With Other Dog
Obsessively Licks/Chews Self
Obsessively Licks People
Obsessively Licks Toys, Objects, or Furniture
Obsessive Wool Suckling (Blankets, Sheets, Cloth)
Uses Toys Or Objects as A Pacifier
Eats Non Food Items
Tail Biting
Tail Chasing
Walks In Small Circles
Walks In Large Circles
Paces
Excitability
Overactivity
Imaginary Fly Chasing
Staring at/Chasing imaginary Objects
Uncontrollable Urination When Excited
Uncontrollable Urination When Frightened
Bedwetting While Sleeping
Shyness/Timidity
Additional Problems Not Listed
If You Selected Additional Problems, Please List And Describe:
What Are Your Overall Goals To Accomplish Through Training? Please List In Order Of Importance:
*
END
Print
Save
Submit
Should be Empty: