Initial Behavior Evaluation Form
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General
Client's Name
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First Name
Last Name
Zipcode
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Email
*
example@example.com
Dog's Name
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Breed (If Known)
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Sex
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Please Select
Male
Female
Intersex
Spayed/Neutered
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Please Select
Yes
No
Unknown
Weight (in Pounds)
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Session Type
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Phone
Virtual
Preferred Consultation Date
*
-
Month
-
Day
Year
Date
Preferred Consultation Time
*
Hour Minutes
AM
PM
AM/PM Option
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Background
What are the main behavior concerns you’d like to address?
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Referral Source
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Veternarian
Trainer
Shelter/Rescue
Online Search
Other
Describe your home environment (house, apartment, yard, fencing, etc.)
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List other pets living in your home (species, breed, age, temperament).
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List all people in the household (adults, children, ages).
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Describe your dog’s typical day (feeding times, walks, alone time, etc.).
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Equipment in Use
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Flat Collar
Harness
Head Halter
Crate
Muzzle
Prong Collar
Electronic Collar
Other
If Other, what?
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Medical & Veterinary History
Vet Name
First Name
Last Name
Clinic Email
example@example.com
Clinic Phone Number
Please enter a valid phone number.
Last Exam Date
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Month
-
Day
Year
Date
Diagnoses/Medical Concerns
Medications / Supplements
Describe your dog’s diet, feeding times, and any allergies
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Training History
Describe any previous training your dog has received (classes, private sessions, online programs).
Training Methods Used
Positive Reinforcement (Rewards)
Clicker Training
Balanced Training
Aversive Tools (Prong, E-collar, etc.)
LIMA (Least Intrusive, Minimally Aversive)
Other
If Other, Please List
What cues/commands does your dog know (e.g., sit, stay, come)? How reliable are they?
Preferred Rewards
Treats
Toys
Games (Ie Fetch/Tug)
Praise/Affection
Other
If Other, What?
What is your dog's absolute favorite reward?
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Behavior History
Aggression
Toward People
Toward Other Dogs
Toward Other Animals
Other
If Other, Please Explain
Please describe any incidents or triggers for aggressive behavior.
Fear/Anxiety
Loud Noises
Strangers
Handling/Grooming
Other
If Other, Please Explain
Describe your dog’s fearful or anxious responses and situations.
Reactivity
Barking
Lunging
Growling
Snapping
Biting
Other
If Other, Please Explain
Describe when and where your dog shows reactive behavior.
Compulsive Behaviors
Tail Chasing
Excessive Licking
Spinning
Chewing/Scratching
Other
If Other, Please Explain
Describe any repetitive or compulsive behaviors.
List any additional behavior concerns not covered above.
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Environmental/Lifestyle
Describe your dog’s daily physical activity and mental enrichment (walks, play, puzzle toys, training games).
Where and how much does your dog sleep during the day and night?
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How often does your dog interact with new people, dogs, or environments?
How does your dog react to being handled for vet exams, grooming, nail trims, or similar care?
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Terms and Conditions and Digital Signature
By Submitting This Form, I Understand I Will Be Redirected To the Terms and Services and Cancellation Policy Page. I Must Agree And Sign It To Receive Continue With Services.
*
I Understand And Agree
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