Dog Behavior Appointment Questionnaire

Dog Behavior Appointment Questionnaire
Owner*

First NameLast Name
Pet*

First NameBreed
Health and Medical History
Is your dog currently on any medication?*

YesNo
If yes, please list:
Does your dog have any known allergies?*

YesNo
If yes, please list:
Has your dog had any previous surgeries or health issues?*

YesNo
If yes, please list:
Has your dog been evaluated by a vet for behavior issues?*

YesNo
Is your dog up-to-date on vaccines?*

YesNo
Any recent changes in your dog's health (e.g., lethargy, pain)?*

YesNo
Behavior Concerns
What specific behavior issues would you like addressed during the appointment? (e.g., excessive barking, aggression, separation anxiety, destructive behavior, fear of certain stimuli, etc.)*
How long have you noticed these behaviors? *
Has the behavior worsened, improved, or stayed the same over time?*

WorsenedImprovedStayed the same
If worsened, when did the change occur?
What steps have you taken to address the behavior(s) so far?*

Professional trainingBehavior modification techniquesMedicationsOther
Has your dog every been involved in any aggressive incidents?*

YesNo
If yes, please describe
Does your dog exhibit signs of fear or anxiety*

YesNo
If yes, please specify
Is your dog fearful of any specific people, places, or situations?*

YesNo
If yes, please describe
Does your dog display any signs of compulsive behaviors (e.g., excessive licking, tail chasing, etc.)?*

YesNo
If yes, please describe
Training and Socialization History
Has your dog received any formal training?*

YesNo
If yes, what type of training?

Basic obedienceAdvanced obedienceBehavior modificationOther
Has your dog attended any socialization classes or group settings? question*

YesDog
How does your dog typically react around other dogs?*

FriendlyFearfulNeutralReactive(e.g., lunging, barking)
How does your dog behave around strangers?*

FriendlyShyNeutralReactive(e.g., lunging, barking)
How does your dog behave around children?*

FriendlyShyNeutralReactive(e.g., lunging, barking)
How does your dog behave during walks or on leash?*

PullsJumpsBarksCalm
Does your dog have any previous history of trauma or abuse?*

YesNo
If yes, please explain:
Daily Routine and Environment
What type of living environment does your dog have?*

ApartmentHouse with yardRural/Outdoor environmentOther
How much exercise does your dog get each day?*

Less than 30 minutes30-60 minutes1-2 hoursMore than 2 hours
Does your dog interact with other pets in the household?*

YesNo
If yes, describe the interaction:
Where does your dog spend most of the day?*

InsideOutsideCrateFree roamOther
Does your dog have access to any enrichment activities (e.g., puzzle toys, interactive play, training)?*

YesNo
Is there anything in the dog’s environment that you believe could be contributing to their behavioral issues?*

YesNo
If yes, please describe:
Goals for This Appointment
What specific goals or changes would you like to see in your dog’s behavior after this appointment? *
Are there any specific techniques or training approaches you are particularly interested in?*

Positive reinforcementClicker trainingRelationship-based trainingOther
Should be Empty:

Dog Behavior Appointment Questionnaire

Health and Medical History

Behavior Concerns

Training and Socialization History

Daily Routine and Environment

Goals for This Appointment