Canine Behavior Questionnaire

Canine Behavior Questionnaire
OWNER INFORMATION
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
DOG INFORMATION

If you are inquiring about more than one dog please complete an additional form.
Name
Breed
Age
Sex

MaleFemale
Referred By:
PRESENTING PROBLEM #1
What is the main reason/problem that you are inquiring about?
Background: When did you first notice tendencies of this problem behavior?
Has there been a recent change in the behavior? (More frequent? More intense? Different circumstances?)
How often does it occur?
Can you anticipate when it is likely to happen? (When, where, who is present, trigger, etc.)
Why do you think your dog is doing this?
What have you done so far to address this problem? With what effect?
What would you consider an acceptable goal/outcome of a training program?
Please describe several recent incidents in as much detail as possible.
PRESENTING PROBLEM #2

or skip to next section
What is the secondary reason/problem that you are inquiring about?
Background: When did you first notice tendencies of this problem behavior?
Has there been a recent change in the behavior? (More frequent? More intense? Different circumstances?)
How often does it occur?
Can you anticipate when it is likely to happen? (When, where, who is present, trigger, etc.)
Why do you think your dog is doing this?
What have you done so far to address this problem? With what effect?
What would you consider an acceptable goal/outcome of a training program?
Please describe several recent incidents in as much detail as possible.
OTHER BEHAVIOR PROBLEMS
Check all that apply and are a concern to you and give details.

AnxietyAggression - PeopleAggression - DogsAggression - Other animalsBarking, vocalizing excessivelyChasing moving objects (bike, vehicle, etc.)Chasing people or dogsCounter SurfingDemanding, attention seekingDestructive (chewing, scratching, etc.)DiggingDoor dashingEscaping (Fence jumping, etc.)FearHouse soilingJumping upRunning offSeparation distressStealing food, objectsUnruly (Jumping, mouthing, etc.)Other: humping, eating non food objects, compulsive behavior...
Please describe...
HEALTH AND VETERINARY INFORMATION
Veterinary Clinic
Past relevant medical or health conditions or important medical history (allergies, medication, injury, etc)? If yes, please describe...
Have you specifically asked your Veterinarian about any of your dog’s training and behavior concerns? If yes, what was their advice?
Please describe your dog’s behavior at the veterinary office?
BACKGROUND INFORMATION
Where did you get your dog from? Include name of organization if known.
How old was your dog when you got him/her?
What do you know as fact about your dog’s background?
What are some of your reasons for choosing this particular dog?
HOUSEHOLD
Do you live in

a housea condoan apartmentother
Relevant changes or dynamics that may affect your dog:
Is anyone in your family afraid of, or dislike your dog?
DIET AND FEEDING
What do you feed your dog? Please be specific (Brand, variety, canned, dried, raw, homecooked, etc.)
How food motivated is your dog? 1 - 10 (finicky ... voracious)
Please describe your dog’s mealtime. (Where, when, how often, who feeds, special routine, etc.)
Does your dog guard their regular meal against humans? (growl, snap, etc.)
Please describe any treat routine your dog has. (Who, what kind of treat, etc.)
ROUTINES

Activities
What would your dog say that her/his favorite pastimes are?
Play: What types of play do you engage in with your dog? Please describe.
Exercise: What types of exercise does your dog regularly get?
Leash Walks: Please describe: How often? Where? How does your dog act on leash?
Walking gear: Please describe: What kind of leash, collar or harness do you use now?
What have you tried in the past?
Off leash time: Does your dog get off leash time? Please describe: Why or why not? Give any details.
Muzzle: Does your dog use a muzzle for any reason?
ROUTINES

Home Alone
How long is your dog left alone on an average day?
Where is your dog kept when you are not home?
What does your dog do when left home alone? Fine? Okay? Anxious/distressed?
What is your dog’s behavior like when you leave home and return?
Is your dog content in a crate? If no, please describe history of exposure.
ROUTINES

Home Together
Day: What does your dog do when you are at home and not interacting with them?
Is your dog allowed on furniture?

YesNoWith permissionType option 4
Do you have any special rules and boundaries in your home, yard, etc.?
Where does your dog rest in the day when you are home?
Night: Where does your dog sleep at night?
Are they a sound sleeper or easily disturbed? Settle easily? Please describe.
Meal time: What does your dog do when you have your meals/snacks?
ROUTINES

Visitors
How does your dog react when familiar people come to your home? Please describe: (Bark, jump, mouth, calm, etc.)
How does your dog react when unfamiliar people come to your home? Please describe: (Bark, jump, mouth, calm, etc.)
ROUTINES

Vehicle Outings
Does your dog join you on car rides? Please describe: (How often? Where? How does your dog act? What type of vehicle? Where in the vehicle do they ride? etc.)
ROUTINES

Grooming and Handling
Which grooming tasks do you perform yourself? List: (Bathing, brushing, trimming, nail clipping, teeth cleaning, ear cleaning, none, other...)
How does your dog react? Please describe: (Calm, struggle, resist certain parts, bite, use a muzzle, etc.)
Does your dog go to a groomer?
Breed
ROUTINES

Eliminations
Is your dog fully housetrained?
Does your dog urinate when excited/greeting/stressed, etc? Please describe.
Any other details?
ROUTINES

Other Activities
Please describe: Enrichment, games, jobs, etc.
TEMPERAMENT
What do you like about your dog? Name 2 or 3...
What do you find most annoying about your dog? Yes, you can mention that , Name 2 or 3...
TRAINING
What are some training goals that you would like to work towards?
What are some of your training successes? Tricks count.
What are some of your training challenges?
How do you let your dog know when they have done something “good”?
What are some of your dog’s favourite rewards? Be specific.
How do you let your dog know when they have done something “bad”?
What types of corrections have you tried or currently use? (interrupt, redirect, time out, verbal reprimand, physical reprimand, scruff, muzzle grab, alpha roll, squirt bottle, throw chain, shake can, choke collar, pinch collar, citronella collar, electronic/stimulation/shock collar, etc.)
With what effect? (ie: no change, stopped behaviour, got worse, only worked with certain person, etc.)
Has your dog participated in any professional training before? If yes, please describe.
What type of methods were used?
How was your experience and the results?
Have you ever used the services of a trainer with a past dog? If yes, with who? Please describe the experience: (Reason, training given, outcome, etc.)
SOCIABILITY

Interactions with Dogs
How would you describe your dog’s sociability with other dogs in general?

dog socialdog tolerantdog selectivedog defensivedog aggressive
What is your dog’s typical play style: Chase? Bully? Wrestle? Body slam? Other?
Does your dog attend doggie day care, dog walker or a boarding facility?
Does your dog regularly attend “Dog Parks”? If yes, please describe: park type, dog interactions, your dog’s behavior, etc.
If yes, please describe.
Have they bitten another dog and broken skin?
What is the ratio of “fights” to bites? Exampe: 20 fights and one bite.
Has your dog ever been bitten by another dog? If yes, please describe.
SOCIABILITY

Interactions with other animals
What is your dog’s experience with cats?

buddies/amiabletoleratesinjured/killed
Any negative experience with other domestic animals? (horse, chickens, etc.)
Has your dog had experiences with wildlife that worried you?
SOCIABILITY

Interactions with people
Has your dog ever bitten a person? If yes, please describe.
Have they bitten and bruised or broken skin?
In what situations does your dog tend to act aggressively towards people?
When people approach their food, dish, bone, etc.?
When people approach their possessions, toy, etc.?
When people approach their bed, couch, etc.?
When being handled, grabbed, restrained, etc.? If yes, please describe.
If disturbed while resting or sleeping?
When visitors come to the home and property?
When visitors move around inside the home? If yes, please describe.
When out on a walk and sees people in distance? If yes, please describe.
When out and about and people pass. Jogging, on bikes, skateboards, etc.?
When around familiar children?
When around unfamiliar children?
When around toddlers? If yes, please describe.
When around babies?
Number of bites that broke skin:
Total number of bites (that did or did not break skin):
Total number of episodes of aggression (growling, snapping, biting):
Please describe typical episode (does dog growl, lunge or bite, and in what circumstance?):
If the dog is in the above situation 10 times, in how many of those times is aggression seen (all=100%, just one=10%, etc.)?
What parts of the body has the dog bitten and how severe were the injuries?
Who is/are the target(s) of aggression?
Did your dog show worrisome behavior as a puppy?
How old was your dog the first time he/she growled at a person?
Is there anything else that you would like us to know about your situation or your dog?
RATE FROM 1 – 6

1 - I would like to learn more but the problem is not serious
2 - I would like to change problem but it is not serious
3 - The problem is serious and I would like to change it, but if it remains unchanged that’s all right.
4 - The problem is very serious and I would like to change it, but if it remains unchanged I will keep my dog.
5 - The problem is very serious and I would like to change it; if it remains unchanged I will have my dog euthanized or give him/her up.
6 - I have almost given up already and am seriously considering having my dog euthanized or giving him/her up.
Please rate:
How much time per day total are you able to dedicate to training? (in 10-minute increments. ie: total 1 hour)
Should be Empty:

Canine Behavior Questionnaire

OWNER INFORMATION

DOG INFORMATION

PRESENTING PROBLEM #1

PRESENTING PROBLEM #2

OTHER BEHAVIOR PROBLEMS

HEALTH AND VETERINARY INFORMATION

BACKGROUND INFORMATION

HOUSEHOLD

DIET AND FEEDING

ROUTINES

ROUTINES

ROUTINES

ROUTINES

ROUTINES

ROUTINES

ROUTINES

ROUTINES

TEMPERAMENT

TRAINING

SOCIABILITY

SOCIABILITY

SOCIABILITY

In what situations does your dog tend to act aggressively towards people?