Saskatoon SPCA Behaviour Intake Form
Please fill out the form below prior to your first session. The information in this form will help us come to our first session well prepared to use our time most effectively. The form starts with general background and progresses to details about your behaviour concerns. Please take time to answer every question in as much detail as possible. If a question really does not apply, you can respond "NA", but please try not to leave answers blank.
Your Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Dog's Name
Dog's Age
Dog's Breed
Is your dog neutered/ spayed?
How long have you had the dog?
How / why did you choose this dog?
Health Background
What is your dogs veterinarian?
Last veterinary visit?
-
Month
-
Day
Year
Date
Is your dog up to date on vaccinations?
Yes
No
Unsure
Unable to be vaccinated
Have you ever discussed your behavioural issues with your veterinarian? If so, what did they suggest.
Describe any health or physical issues your dog has.
Describe any prior illnesses and all surgeries.
List all currently used medications and supplements.
Nutrition
What brand(s) and flavours/types of food does your dog eat?
Describe this dog's feeding schedule (when, where, what type of bowl, etc.)
List any known food allergies or sensitivities.
What are your dogs FAVOURITE foods / treats?
Does your dog protect or guard food / treats from other people or other dogs? If so, please describe.
Home Environment
Home type
List the name, age, and gender of all people in the home.
List the name, age, sex, and species/breed of all pets in the home.
How does your dog get along with each of their housemates (human and other pets)?
Where is your dog when you have guests over?
Do you have a securely fenced yard?
Do you use an electronic containment system (ie/ "invisible fence")
Describe your dogs daily exercise schedule.
What games do you play with your dog?
What are your dog's FAVOURITE toys or games?
Does your dog protect or guard toys from people or other dogs? If so, please describe.
Training History
What level or how much training has this dog had?
Who did the training?
What kinds of collars have you used with this dog?
Flat or rolled, nylon or leather
Martingale / limited slip
choke / check collar
pinch / prong collar
remote electronic (Vibration / shock)
Fence / Barrier electronic (Vibration/ shock)
Bark Electronic (Vibration / Shock)
Citronella Spray
What kinds of leashes have you used with this dog?
six foot or shorter leash
long line (over 10 feet)
retractable leash
What other training equipment have you used?
Head halter / face collar
Classic body harness
No-pull harness
Baby gate / barrier
Clicker
Calming cap / Thunder Shirt
Muzzle
Noise maker / shaker can
Spray bottle
Thrown objects
Dog whistle
What kinds of rewards do you use for this dog?
Audible marker (click, "yes")
Verbal praise
Touch / affection
Play (tug, fetch, chase, etc.)
Food / Treats
Outings (car rides, walks, etc.)
What kinds of punishments do you use for this dog?
Verbal reprimand ("no", "-eh", "tsst", etc.)
Withhold attention / leave room
Yank on leash
Grab / scruff
Yell
Poke / hit / kick
"Alpha" roll
Stare at dog
Time out / isolation (in crate or other room)
List cues / commands that your dog responds to reliably (80% of the time).
List any tricks you've taught this dog to do.
Solo Time
How comfortable is your dog in their crate ("NA" if no crate is used)?
How much time each day (other than overnight) does your dog spend in a crate?
Where does your dog sleep at night?
Where is your dog when left alone?
What does your dog do as you are about to leave the home?
How does your dog behave when you return home?
Describe any damage or soiling done by your dog when left alone.
Does your dog bark, whine, or vocalize excessively when alone?
Confidence / Anxiety
Describe your dog's energy or activity level.
Do you think this activity level is normal and appropriate for your dog?
Describe your dog's reaction to people coming to the door.
Describe your dog's reaction to strangers while on a walk.
Describe your dog's reaction to unfamiliar dogs while on a walk.
Describe your dog's reaction to thunderstorms or loud noises.
Does your dog startle to anything else (ie/ flashes of light, sudden movement, etc.)
Check each of the following that you can readily do to this dog without a fuss:
Handle Feet
Handle ears
Handle tail
Trim nails
Brush / groom
Put on / remove collar or harness
Take away empty food bowl
Take away toys
Move from couch / furniture
Visit a dog park
Visit a pet store or other public place
Human-directed Aggression
Which of the following best describes the worst bite to a human by this dog:
Level 0. This dog has no bite history or aggression towards people.
Level 1. Obnoxious or aggressive behaviour but no skin-contact by teeth.
Level 2. Skin contact by teeth but no skin punctures. There may be skin nicks (less than one tenth of an inch deep) and slight bleeding cause 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 dogs canine teeth. There may be lacerations in a single direction, caused by victim pulling hand away or owner pulling the dog away.
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 or lacerations.
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. A victim has died as a result of the attack.
How many times, excluding play, has there been tooth-to-skin contact from this dog?
Who received the worst bite from this dog?
Where was your dog?
Where was everyone else around your dog?
What was everyone doing just before the bite incident?
What did your dog do?
Describe your dog's body language (posture, ears, tail, face, hair, etc.)
What was your reaction (or the reaction of the person responsible for the dog)?
What was the reaction of the victim / target?
Describe your dog's behaviour directly after the incident.
Did you attempt to punish or discipline your dog for this incident, and how?
Dog-directed Aggression
Which of the following describes the worst bite to another dog by this dog?
Level 0. There is air snapping but no contact to the fur or skin (fur should be dry — if the fur is wet, contact was made and the bite is not a Level 0).
Level 1. A bite and release with contact to the fur, superficial scratches or removal of fur. No more than 5% of the dog's canine teeth entered the other dog's body or a bite where a dog grips another dog's body and does not release but does not result in any injury.
Level 2. A bite and release where 5 to 15% of the dog's canine teeth entered the other dog's body.
Level 3. There are lacerations or punctures where 15 to 30% of the dog's canine teeth entered the other dog's body. There may be tearing of the skin from the underlying musculature or subcutaneous pockets.
Level 4. There are deep lacerations where 30 to 50% of the dog's canine teeth entered other dog's body or there was a report or evidence of shaking of the head. There are no crushing injuries or serious internal injuries.
Level 5. A bite with holding pressure and possibly shaking of the head — external injuries may or may not be present, but serious internal injuries are present.
Level 6. A victim dog has died as a result of the attack.
Where was your dog?
Who else (dogs and people) were around your dog?
What was everyone doing just before the bite incident?
What did your dog do?
Describe your dog's body language (posture, ears, tail, face, hair, etc.)
What was your reaction (or that of the person responsible for the dog)?
What was the reaction of the victim / target?
Describe your dogs behaviour immediately after the incident.
Did you attempt to punish or discipline your dog for this incident, and how?
Primary Concerns
What is the primary concern that brought you here?
How often does this problem behaviour occur?
Describe in detail the most recent occurrence of this problem.
Describe in detail the most severe occurrence of this problem.
Describe in detail the first time you noticed this problem.
What have you tried so far to address the problem?
Are there any other behavioural concerns?
Finishing up
Are you willing to accept praise and critiques of your handling of your dog and cooperate with any recommendations made?
Are you willing to make changes to your dog's environment or routine, and accept suggestions regarding equipment changes, managing behaviour, veterinary check-ups, etc.?
Describe any concerns or hesitations you may have to answering "yes" to either of the two previous questions.
Please describe your learning style or what modes or methods of feedback would be most helpful for you.
List three things you love about your dog.
Submit
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