Dog Behavior Questionnaire

Dog Behavior Questionnaire
- Basic Information
- Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Referred By (Vet, Friend, Trainer)
- Veterinarian Clinic
- Veterinarian Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Veterinarian Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Upload a Copy of Vet Records (Bloodwork, Labs, ETC.)
  
  Cancelof
- Pet Data
- Pet Information of Pet's Needing Training
- Reason(s) For Consult
- 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:
- 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?
- Previous Training
- Has There Been Any Formal Training Previously?
- What Kind Of Training Previously?
- 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?
  
  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?
- Handling
- Does Your Dog React Negatively To Any Types Of Handling?
  
  Other
- Describe How Your Dog Reacts to Anything Marked Above:
- 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?
- What Kind Of Appetite Does Your Dog Have?
- Describe Your Dog's Stool
- What Are Your Pets' Favorite Treats? List Top 5:
- House-Training Screening
- Was Your Pet Ever Completely House-Trained?
- 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?
- Is Your Dog Ever Crated?
- Does Your Dog Ever Soil Their Crate?
- Does Your Dog Leak Urine When:
- Separation Anxiety Screening
- Does Your Dog Display Separation Anxiety?
- Please Describe Your Dogs' Behavior When Left Alone
- Score Your Dog's Separation Anxiety 1-10
- Fears And Phobias Screening
- List Any Triggers That Cause Your Dog Anxiety/Fears/Phobias (People, Dogs, Loud Noises, Objects, Stairs, Vacuum, Children, ETC)
- Aggression Screening
- Has Your Dog Ever:
- Situations That Caused Aggression
- Petting/Handling
- Which Dog? Please Describe
- Eating or Being Approached While Eating
- Which Dog? Please Describe
- Attempting To Take Food While Eating
- Which Dog? Please Describe
- Chewing Stolen Objects/Toys
- Which Dog? Please Describe
- Attempting to Take Away Stolen Objects/Toys
- Which Dog? Please Describe
- Trimming Nails/Bathing/Brushing
- Which Dog? Please Describe
- Staring At Dog
- Which Dog? Please Describe
- Scolding Dog
- Which Dog? Please Describe
- Leash Or Collar Correction
- Which Dog? Please Describe
- Physically Reprimanding Dog
- Which Dog? Please Describe
- Raising Hand Over Dog
- Which Dog? Please Describe
- Bending Over Or Leaning Over Dog
- Which Dog? Please Describe
- Hugging or Kissing Dog
- Which Dog? Please Describe
- Grabbing Collar
- Which Dog? Please Describe
- Rolling Your Dog Over
- Which Dog? Please Describe
- Disturbing While Sleeping
- Which Dog? Please Describe
- While Dog Is On Furniture or Bed
- Which Dog? Please Describe
- Attempting To Remove Dog From Furniture or Bed
- Which Dog? Please Describe
- Aggression Towards People (Skip This Section If Your Dog Is Not Aggressive Towards People)
- Does Your Dog:
- 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?
- 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?
- Which Dog? Describe:
- Is Your Dog Ever Aggressive Towards Strangers?
- 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:
- Aggression Towards Other Dogs (If Your Dog Is Not Aggressive Towards Other Dogs, Skip This Section
- Does Your Dog
- Which Dog? Describe:
- What is The Potential For Injury To Another Dog? Describe:
- 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:
- Additional Behavior Problems
- Do You Have Any Issues With The Following?
- If You Selected Additional Problems, Please List And Describe:
- What Are Your Overall Goals To Accomplish Through Training? Please List In Order Of Importance:
- Should be Empty:

Dog Behavior Questionnaire

Basic Information

Pet Data

Backgroun Information

Family Information

Previous Training

Handling

Medical Screening

House-Training Screening

Separation Anxiety Screening

Fears And Phobias Screening

Aggression Screening

Situations That Caused Aggression

Aggression Towards People (Skip This Section If Your Dog Is Not Aggressive Towards People)

Aggression Towards Other Dogs (If Your Dog Is Not Aggressive Towards Other Dogs, Skip This Section

Additional Behavior Problems