• Canine Behavioral History Form

    Canine Behavioral History Form

    Fairfax Campus
  • At which location are you requesting an appointment?*
  • Primary Owner preferred pronouns*
  • Format: (000) 000-0000.
  • Co-Owner preferred pronouns
  • Format: (000) 000-0000.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Is date of birth known or estimate?*
  • How did you acquire this dog?*
  • 0/150
  • 0/150
  • 0/300
  • 0/200
  • If aggression, what was the result to the victim(s)? (mark all that apply)*
  • If aggression, what was the result to the victim(s)?*
  • Which of the following injuries were sustained? (Please mark all that apply)*
  • Did the victim(s) seek professional medical treatment?*
  • What type of medical intervention was needed? (Please mark all that apply)*
  • Are you able to provide a photo/photos of the injuries sustained by the victim(s)?*
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • How often does this type of incident occur?*
  • 0/80
  • This problem is getting:*
  • 0/80
  • Is there any legal action (pending or resolved) regarding these incidences?*
  • Rows
  • Rows
  • Have you previously owned dogs?*
  • Have you previously owned this breed of dog?*
  • How do you feed your dog?*
  • Do you need to be present for your dog to eat?*
  • Is your dog protective of meals/food?*
  • Does your dog wake you up at night?*
  • If you have a backyard, what type of fencing does it have?*
  • Does your dog run the fenceline barking?*
  • What type of exercise does your dog get on a daily basis? (mark all that apply)*
  • Is there any specific time devoted to training per day?*
  • Is your dog playful?*
  • Where does your dog stay when no one is home?*
  • Do you record/monitor your pet when it is home alone?*
  • Does your dog exhibit any of the following behaviors when left home alone? (check all that apply)*
  • If house soiling, does the problem occur:
  • What arrangements are made if you are out of town?*
  • Has your dog ever attending professional training classes?*
  • How would you rate your dog's ability to learn?*
  • To which cues does your dog respond with reliability?*
  • Does your dog pull on leash?*
  • What types of training aides do you CURRENTLY use? (check all that apply)*
  • Which of the following training aides have you used in the PAST? (check all that apply)*
  • What type of home do you live in?*
  • How would you describe your home?*

  • Aggression

    Aggression can include any of the following: barking, snarling, lunging, muzzle punching, snapping (no contact), nipping, biting.

  • Rows
  • Is your dog quick to approach visitors in the home?*
  • Rows
  • Does your dog show inappropriate mounting or other sexual activity?*
  • Is your dog protective of certain parts of his/her body?*
  • Does your dog lick or chew themselves more than you would expect?*
  • Does your dog lick or chew other things (people or surfaces) more than you would expect?*
  • What is your dog's response to veterinary handling/intervention? Please check ALL that apply:*
  • Does your dog display reactions to thunderstorms?*
  • Does your dog display reactions to fireworks?*
  • Does your dog startle at loud noises that are not thunder, fireworks, or gunshots? (ex. if you drop a book, if you clang a pot or pan)*
  • Does your dog display any of the following reactions when traveling in the car? (mark all that apply)*
  • Does your dog ever do any of the following? (mark all that apply)*
  • Should be Empty: