Canine Behavioral Assessment & Research Questionnaire

Owner's Name

First NameLast Name

Pet's Name

SECTION 1: Excitability
INSTRUCTIONS: Some dogs show little reaction to exciting events, while others become highly excited at the slightest novelty.

Please indicate your own dogʼs recent tendency to become excitable in the following circumstances:

1. Just before being taken for a walk.

	Calm: Little to no reaction	Mild	Mild-Moderate	Moderate	Extremely excitable: over-reacts, hard to calm down.

2. Just before being taken on a car trip.

	Calm: Little to no reaction	Mild	Mild-Moderate	Moderate	Extremely excitable: over-reacts, hard to calm down.

SECTION 2: Aggression
INSTRUCTIONS: Most dogs display aggressive behavior from time to time—e.g. barking, growling, baring teeth, snapping, etc.

Please indicate your own dogʼs recent tendency to display aggressive behavior in each of the following circumstances:

3. When approached directly by an unfamiliar person while being walked/exercised on a leash.

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

4. When toys, bones or other objects are taken away by a household member

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

5. When approached directly by a household member while s/he (the dog) is eating.

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

6. When mailmen or other delivery workers approach your home

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

7. When his/her food is taken away by a household member.

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

8. When approached directly by an unfamiliar dog while being walked/exercised on a leash.

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

9. When strangers walk past your home when your dog is outside or in the yard.

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

10. When barked, growled, or lunged at by another (unfamiliar) dog.

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

11. When approached while eating by another (familiar) household dog (leave blank if no other dogs).

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

12. When approached while playing with/chewing a favorite toy, bone, object, etc., by another (familiar) household dog (leave blank if no other dogs).

	No aggression: No visible signs of aggression	Moderate Aggression: Growling/Barking	Moderate Aggression: Baring teeth	Serious aggression: Snaps, bites or attempts to bite

SECTION 3: Fear and Anxiety
INSTRUCTIONS: Dogs often show signs of anxiety or fear when exposed to particular sounds, objects, persons or situations—e.g. crouching or cringing with tail tucked between the legs; whimpering or whining, freezing, trembling, or attempting to escape or hide.

Please indicate your own dogʼs recent tendency to display fearful behavior in the following circumstances:

13. When approached directly by an unfamiliar person while away from your home.

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

14. In response to sudden or loud noises (e.g. thunder, vacuum cleaner, car backfire, road drills, objects being dropped, etc.).

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

15. When an unfamiliar person tries to touch or pet the dog

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

16. In response to strange or unfamiliar objects on or near the sidewalk (e.g. plastic trash bags, leaves, litter, flags flapping, etc.

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

17. When approached directly by an unfamiliar dog.

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

18. When first exposed to unfamiliar situations (e.g. first car trip, first time in elevator, first visit to veterinarian, etc.).

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

19. When barked, growled, or lunged at by an unfamiliar dog.

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

20. When having nails clipped by a household member.

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

21. When groomed or bathed by a household member.

	No fear/anxiety: No visible signs of fear	Mild	Mild-Moderate	Moderate	Extreme fear: cowers; retreats or hides, etc.

SECTION 4: Separation-related behavior.
INSTRUCTIONS: Some dogs show signs of anxiety when left alone, even for short periods of time.

Thinking back over the recent past, how often has your dog shown each of the following signs of anxiety when left, or about to be left, on its own:

	Never	Seldom	Sometimes	Usually	Always
22. Restlessness/agitation/pacing.
23. Barking or whining.
24. Chewing/scratching at doors, floor, windows, curtains, etc.

SECTION 5: Attachment and Attention-seeking.
INSTRUCTIONS: Most dogs are strongly attached to their people, and some demand a great deal of attention and affection from them.

Thinking back over the recent past, how often has your dog shown each of the following signs of attachment or attention-seeking:

	Never	Seldom	Sometimes	Usually	Always
25. Tends to follow you (or other members of the household) about the house, from room to room.
26. Tends to sit close to, or in contact with, you (or others) when you are sitting down

SECTION 6: Training and obedience
INSTRUCTIONS: Some dogs are more obedient and trainable than others.

By checking the appropriate boxes, please indicate how trainable or obedient your dog has been in each of the following situations in the recent past:

	Never	Seldom	Sometimes	Usually	Always
27. Obeys a “sit” command immediately.
28. Obeys a “stay” command immediately
29. Easily distracted by interesting sights, sounds or smells.

SECTION 7: Miscellaneous problems
INSTRUCTIONS: Dogs display a wide range of miscellaneous behavior problems in addition to those already covered by this questionnaire.

Thinking back over the recent past, please indicate how often your dog has shown any of the following behaviors:

	Never	Seldom	Sometimes	Usually	Always
30. Chases or would chase birds, given the chance.
31. Chases or would chase squirrels, rabbits, etc., given the chance.
32. Escapes or would escape from home or yard, given the chance..
33. Chews inappropriate objects.
34. Pulls excessively hard when on the leash.
35. Urinates against objects/ furnishings in your home.
36. Urinates when left alone at night, or during the daytime.
37. Defecates when left alone at night, or during the daytime.
38. Hyperactive, restless, has trouble settling down.
39. Playful, puppyish, boisterous.
40. Active, energetic, always on the go.
41. Chases own tail/hind end.
42. Barks persistently when alarmed or excited.

Thank you for providing this helpful information!