Reactive to Proactive Inquiry Form
We use this form to ensure our Reactive to Proactive classes are the best for you and your dog. After you submit the form we will respond within 2 business days.
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Email
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Please make sure this is correct, we will be emailing you registration information.
Dog's Name
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Dog's Breed/Mix
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Approximate weight of the dog
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Dog's Age
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Is your dog a
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Spayed female
Intact female
Neutered male
Intact male
At what age did your dog join your family?
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How long have you had your dog?
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Your Vet Clinic and Contact Info
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Is your dog currently on medication for behavior or has your vet recommended it? If so, what medication and doseage?
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At what age did you notice this behavior in your dog?
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Was there a traumatic event that triggered this behavior? If so, what happened?
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What behavior does your dog display when s/he sees another dog when on leash or from behind a barrier (i.e. window, door, fence)?
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Body gets stiff
Pace increases
Head lifts
Tail is high
Tail is tucked
Heckles are raised
Vocalization (not growling or barking, but whines, grumbles, huffing, etc)
Growls
Barks
Lunges
Pulls
Bites
N/A - Does not have issues with other dogs
What behavior does your dog display when s/he sees a human when on leash or from behind a barrier (i.e. window, door, fence)?
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Body gets stiff
Pace increases
Head lifts
Tail is high
Tail is tucked
Heckles are raised
Vocalization (not growling or barking, but whines, grumbles, huffing, etc)
Growls
Barks
Lunges
Pulls
Bites
N/A - Does not have issues with humans
If your dog has bitten another animal (including dogs), how severe was the bite? (Select as many as needed if there are multiple bite incidents.
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N/A (No bite history)
Level 1. Obnoxious or aggressive behavior but no skin-contact by teeth.
Level 2. Skin-contact by teeth but no skin-puncture. However may be skin nicks (less than one tenth of an inch deep) and slight bleeding caused by forward or lateral movement of teeth against skin but no vertical punctures.
Level 3. One to four punctures from a single bite with no puncture deeper than half the length of the dog’s canine teeth. Maybe lacerations in a single direction- caused by victim pulling hand away- owner pulling dog away or gravity (little dog jumps bites and drops to floor).
Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dog’s canine teeth. May also have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held on and shook its head from side to side).
Level 5. Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in each.
Level 6. Victim dead.
If your dog has bitten a human, how severe was the bite? (Select as many as needed if there are multiple bite incidents.
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N/A (No bite history)
Level 1. Obnoxious or aggressive behavior but no skin-contact by teeth.
Level 2. Skin-contact by teeth but no skin-puncture. However may be skin nicks (less than one tenth of an inch deep) and slight bleeding caused by forward or lateral movement of teeth against skin but no vertical punctures.
Level 3. One to four punctures from a single bite with no puncture deeper than half the length of the dog’s canine teeth. Maybe lacerations in a single direction- caused by victim pulling hand away- owner pulling dog away or gravity (little dog jumps bites and drops to floor).
Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dog’s canine teeth. May also have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held on and shook its head from side to side).
Level 5. Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in each.
Level 6. Victim dead.
If your dog has bitten, please explain, in as much detail as possible.
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Include what lead up to the incident and what happened during the incident.
Have you ever taken group training classes with your dog before? With what company, when, and what methods were used?
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Method Type Examples: Positive reinforcement, clicker training, balanced, prong collars and shock collars.
Have you ever taken private training classes with your dog before? With what company, when, and what methods were used?
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Method Type Examples: Positive reinforcement, clicker training, balanced, prong collars and shock collars.
Have you ever sent your dog to a board and train program? With what company, when, how long was the program, and what methods were used?
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Method Type Examples: Positive reinforcement, clicker training, balanced, prong collars and shock collars.
Please provide any other information about your dog that you like us to know.
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Please verify that you are human
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Submit
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