Behavior Questionnaire 2023
Laurie Tuttle Dog Training LLC 219-776-7312 email: info@laurietuttledogtraining.com YOU MUST FILL OUT/PAY on our "ONLINE PRIVATE FORM", located on the same page you used for this form, IN ORDER TO BOOK YOUR SESSION.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State ( IN or IL )
Postal / Zip Code
Dog's Name
*
Dog's Age
*
Breed(specific as you can be.)
*
Spayed or Neutered
*
Age of Spay or Neuter
*
At what age did you bring your dog home?
*
How long have you had your dog?
*
Where did you hear about Laurie Tuttle Dog Training?
*
Vet/Tech
Groomer
Trainer
Friend
Social Media
Internet Search
Current client
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Medical History
by submission of this Behavioral history form constitutes permission to share your information with your veternarian.
Name of Veterinarian Ciinic
*
Name of primary Veterinarian
*
Veterinarian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veterinarian Phone Number
*
-
Area Code
Phone Number
What brand of food does your dog eat?
Amount of food/How often?
Amount of food/How often?
Who is the primary feeder?
Was the food prescribed/recommended by your vet? (y/n)
Has your dogs appetite Increases/Decreases/No change
Does your dog sleep More, Less, Same
Does your dog(now or in the past) have any medical conditions or health problems?
Is the dog on any medications currently? Why? Please list ALL medications
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Reason For Visit
What is the MAIN behavior problems or complaint?
*
How frequently does the MAIN problem occur?
*
0-3 times a day
More than 3 times a day
0-5 times a Week
More than 5 times a week
0-5 times a Month
More than 5 times a month
Additional Problems #1
How frequently does the Additional problem 1 occur?
0-3 times a day
More than 3 times a day
0-5 times a Week
More than 5 times a week
0-5 times a Month
More than 5 times a month
Additional Problem #2
How frequently does the Additional problem 2 occur?
0-3 times a day
More than 3 times a day
0-5 times a Week
More than 5 times a week
0-5 times a Month
More than 5 times a month
Additional Problem #3
How frequently does the Additional problem 3 occur?
0-3 times a day
More than 3 times a day
0-5 times a Week
More than 5 times a week
0-5 times a Month
More than 5 times a month
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Chronology of the Behavior Problem
At What age did you first notice the Main problem?
At what age did it become a serious concern?
In what general circumstances does the dog misbehave?
Has the Problem Changed in frequency? (please describe)
Has the problem changed in intensity? (please describe)
Date of most recent incident/Please describe the incident in detail
Date of second to incident/Please describe the incident in detail
Date of third to incident/Please describe the incident in detail
Any other significant incidents? Please describe the incident in detail
What have you done so far to correct the problem?
How do you discipline your dog for this and other bad behavior(if you do)/
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Training History
Is your dog House trained?
Does your dog have accidents? How many in a Day/Week/Month
What basic training training has your dog had? Check all that apps
None
I trained my dog at home by myself
Attended Class(es)
Graduated
Graduated Class(es)
Private Trainer
Other
What methods were used in training? (ex: choke chain, pinch collar, martingale, harness, shock collar, treats, toys, clicker - Please be specific_
How old was the dog when training started?
If training ended at what age?
Please list all the people, including yourself, living in your home
Name
Age (of Children)
Hours away from home
1
2
3
4
5
6
Please list all animals in the household, INCLUDING the dog you are bringing, in the the order in which they were obtained.
Name
Species
Breed
Sex
Age Obtained
Age now
1
2
3
4
5
6
Describe your dog's relationship to the other animals
Have you moved since acquiring your dog?
Yes
No
If yes, how many times?
Has your household (people or animals) chanced since since acquiring your dog?
Yes
No
Please describe
Does your dog run free in a fenced yard?
Yes
No
Is the dog tied outside?
Yes
No
Does the dog run free if you don't have a fenced in yard?
Yes
No
If so Where and How often
Do you walk your dog? For how long each time, and how many times a day/week
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Dog's Background
Why did you decide to get a dog?
Why did you choose this breed?
Where did you get this dog?(be as specific as possible - name of shelter/rescue/breeder etc.
Do you have any updates on littermate behavior?(please describe)
If known, please describe the parents' behavior
Why did you choose this dog over the others?
Has this dog had other owners? (Y/N)
If Yes How Many?
If So, why was the dog given up?
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General Behavior
How does the dog behave with visitors? (Children/Adults, Familiar or unfamiliar)
Are there certain types of people your dogs seems to like better than others?(please describe)
How do you play with your dog?
What toys dos the dog have, and how does play with them?
Where is your dog when he's alone in the house?
Where is your dog when you have guests?
How does your dog behave when you are leaving the house?
What is your dog's activity level in general (check one)
Low
Average
High
Excessive
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Aggression Screen(please check all that apply)
GROWL
SNARL/BARE TEETH
SNAP/BITE
NO REACTION
NOT APPLICABLE
Pet Dog
Hug Dog
Kiss Dog
Lift Dog
Call Off Furniture
Push/Pull off furniture
Approach on Furniture
Disturb while resting/sleeping
Approach while eating
Touch while eating
Take dog food away
Take human food away
Take water dish away
Take rawhide/bully stick away
Take biscuit/cookie/treat away
Take real bone away
Take toy/object
Approach when dog has toy/object
Verbally Punish
Physically Punish
Visual threat
Speak to dog(normal tone)
Stare at dog
Bend over dog
Push on shoulders or back
Approach dog near spouse
Enter room
Leave the room
Reach toward dog
Leash restraint
Collar Restraint
Scruff restraint
Put leash on/take off
Put collar on/take off
Bathe Dog
Towel Dog
Groom/brush dog
Dog at groomers
Trim nails
Leash/collar correction
Response to "sit"
Response to "down"
Dog at Vet clinic
Unfamiliar adult enters house or yard
Unfamiliar child enters house or yard
Familiar adult enters house or yard
Familiar child enters house or yard
Response to toddlers/babies
Dog in car at tollbooths, gas stations, drive the
Unfamiliar adult approaches owner when on leash
Unfamiliar child approaches owner when on lease
Dog in house, sees people outside
Response to other dogs while on leash
Response to other dogs while off leash
Which of these best describes you? (check one)
I am here out of curiosity - problem is not serious.
I would like to change the problem, but it is not serious.
The problem is serious, but if remains unchanged I will keep my dog.
The problem is VERY serious, but if it remains unchanged I will keep my dog.
The problem is VERY serious, If it remains unchanged, I will have my dog euthanized or give him/her up.
For Aggression Towards People
Skip this section if aggression is not the problem.
Please Check Yes or No to these Characteristics of your dogs aggressive behavior
Yes
No
Attacks are sudden and surprising
Episodes appear unprovoked
The dog is abruptly docile after an episode
The dog appears "sorry" afterwards
The dog appears disoriented afterwards
Episodes are associated with "glazed" or absent expression
I can usually tell what will set off my dog
The aggressive behavior is new and uncharacteristic
Has your dog bitten?
Type a question
Ansers
Total number of episodes of aggression(growling, snapping, biting,)
Total number of bites
Number of bites that caused bruising
Number of bites that broke skin
Number of bites that required a trip to the doctor/stitches
Describe typical episode (i.e. does dog growl, lunge, or bite, and in what circumstance )
If in the above situation 10 times, how many times is aggression seen?
What parts of the body has the dog bitten?
Who are the targets of aggression?
How old was your dog the first time he/she snapped or bit at a person?
Describe
Anything else you would like to tell us?
Thank you for taking the time to fill out this questionnaire
We will discuss the results during your first training session.
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