Behavior Questionnaire

This information will guide our discussion during your in-home consultation, and will be used to help customize your training program.
Today's Date

MonthDayYear
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Zip
Primary phone #*

Area CodePhone Number
Can we text you at this number?*
Email*
example@example.com
How did you hear about Cathy's K9 Kids?*
Dog's Name*
Dog's Gender*
Dog's age*
Breed(s)*
Is this your first dog?*
What age was your dog when you got him/her?*
What training have you done so far with this dog?*
How will your dog react to a stranger entering the house?*
Please check all behaviors that you're struggling with

Accidents in houseJumps on peoplePulls on walksRefuses to walkLunges at other dogsExcessive barkingDoesn't like other dogsHas attacked another dogWas attacked by another dogHas bitten a personGuards food, treats, toysSelective listening when distractedSelective listening all of the timeSlips out door and runs awayWon't come when called while off leash outsideDoesn't like to be touched in certain areasAfraid of peopleAfraid of other dogsPesters other house petsChews inappropriate objectsWon't give back objects he/she takesGrowls at peopleTries to bite people he doesn't knowGrowls or tries to bite dogs he doesn't knowOther
Have any of the above behaviors become worse or more frequent? If yes which ones?
Are you interested in OFF-LEASH control?*

YES! In my fenced yard ONLYYES! In my yard that is NOT fencedYES! Anywhere I take my dogNO; I only want on-leash controlNot sure; let's discuss
List your top 3 behaviors you want to change

Add anything else you'd like me to know in the next box.
1*
2*
3*
What would you like to do with your dog that you can't do now?*
How is your daily life impacted by your dog's behavior?*
When is the best time to call you?*
Examples: Mon-Fri mornings; noon-5:00PM; between 5:00-7:00PM.
Should be Empty:

List your top 3 behaviors you want to change