Behavior Questionnaire
Please be as detailed as possible. Thank-You
First Name
*
Last Name
*
Phone Number
*
E-mail
*
example@example.com
Pets Name
*
General Information
Primary Care Veterinarian
*
Pet's Current Age
Age when neutered/spayed
Any behavioral changes after neuter/spay?
Current Medication
Please list all medications and dosages
Current Diet
Does your dog travel?
Type a question
Names and breed of other pets in the household.
Names of other people living in the household.
Briefly describe your dog's personality.
(e.g., quiet, confident, excitable, unruly, bold, stubborn, fearful, etc.)
Origin Information
Age when acquired
From where?
How many pervious owners?
Have you met the parents? If so, what were they like?
How many puppies were in the litter?
Why did you choose this specific puppy?
Other notes regarding dog's origin?
Home Enviornment
Types of treats you feed your pet
How often do you give treats?
When do you give treats?
Supplements your pet is taking
Activity and Routine
Types of exercise/play:
Who exercises/play with your pet?
How many walks per day?
How many play sessions per day?
Favorite toys:
Favorite games:
What does your dog do in-between activates?
(e.g., sleep, watch the window, distructive, follows you around, etc.)
Where does your dog sleep?
How is your dog kept when you leave him/her alone?
Training Information
What behaviors/commands does your dog know?
What previous classes or training programs have you done?
What is your dog's sports training history?
Briefly describe training techniques you have used in the past:
Describe your dog's learning ability:
List family member with the most control:
List family members with the least control:
Potty Training
Where is your dog's primary potty location?
On average how many times a day does your dog go potty?
Is your dog completely house trained?
Medical Screening
When was the last time your dog was at the vet?
What is your dog's relationship with food like?
Does your dog have arthritis or any other painful conditions?
Does your pet have any medical problems?
Does your pet have any allergies?
Does your dog have normal bowel movements?
When was the last time your dog had lab work done?
Separation Information
What do you do when preparing to leave the house?
On average, how long is your dog left alone daily?
How does your dog react when you are preparing to leave?
How does your dog behave when left home alone?
Is your dog ever left alone outside?
How does your dog react when you return home?
Noise Response Information
Does your dog show any concern to noises? If yes, please explain.
Dog - Human Struggle Information
How does your dog react to people they know coming into the house?
Hoe does your dog react to people they DON'T know coming into the house?
How does your dog react to people on walks?
Dog - Dog Struggle Information
Does your dog have any other doggie friends they regularly play with?
Does your dog go to doggie parks or doggie daycare?
How does your dog react to dogs that walk past your home?
How does your dog respond to other dogs when on a walk?
How does your dog respond to other dogs when off leash outside of the home?
If you have other dogs that live in the home, how do they get along?
Dog - Cat Struggles
Only fill out this section if there is cat that lives in the home, or pet will be places in a home with other cats.
How does your dog behave with your pet cat/s?
Do you have multiple areas in your house for your cat to get away from your dog?
Resource Guarding Information
When your dog is eating from their food bowl do they display any of the following? Select all that apply.
Growling
Lip Licking
Snarling
Paw Lift
Eating Faster
Whale Eye
Stiff Posture
Freezing
Moving Away
Crouching Over Resource
Piloerection (Raised Hackles)
Running Away with Resource
Trying to Cover or Hide Resource
None of the Above
When playing with toys does your dog display any of the following? Select all that apply.
Growling
Lip Licking
Snarling
Paw Lift
Eating Faster
Whale Eye
Stiff Posture
Freezing
Moving Away
Crouching Over Resource
Piloerection (Raised Hackles)
Running Away with Resource
Trying to Cover or Hide Resource
None of the Above
When your dog has a chew toy does your dog display any of the following? Select all that apply.
Growling
Lip Licking
Snarling
Paw Lift
Eating Faster
Whale Eye
Stiff Posture
Freezing
Moving Away
Crouching Over Resource
Piloerection (Raised Hackles)
Running Away with Resource
Trying to Cover or Hide Resource
None of the Above
Does your dog seem to be protecting or guarding you from other dogs or people? If so, please explain.
Does your dog seem stressed or upset when you or other pets approach them when they are resting in certain areas? If yes, please explain.
Do you have any other concerns about resource guarding?
Struggle History
What is the problem?
When did it first occur?
How has it progressed?
Did it occur suddenly or develop slowly over time?
Is the problem always present?
What do you think caused the problem?
Have there been any recent changes in severity or frequency?
Treatment History
What have you done to try to resolve the problem?
Have you seen a Veterinary Behaviorist?
Has anything made the problem worse?
Goal List
What are your top three training goals?
Submit
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