Behavioral Assessment Form
Please answer each question as completely and honestly as possible. If the question doesn't apply or you don't know the answer enter N/A, NONE or I don't know. Every question requires an answer. You will not be able to submit the application if you've missed a question. You can save your progress and return later to complete the assessment form. Once we have your completed form we will review the information you've provided and then reach out to schedule your consultation.
Name
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First Name
Last Name
Dogs Name
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Breed/Breeds if a mix
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Is this dog purebred?
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Yes
No
Dogs Current Age, best guess if unsure.
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Dogs Date of Birth, best guess if unknown.
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Dogs Sex
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Please Select
Male
Neutered Male
Female
Spayed Female
If altered, at what age?
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Address
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Home Address
Mailing address/P.O Box
City
State
Zip Code
Phone Number
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Format: (000) 000-0000.
E-mail
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example@example.com
Are there children in the home? Please list names and ages
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Other household members? Spouse/Partner/Roommate? Please list name and relationship.
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Other dogs/pets in the family? Please list species, name and age. If a dog or cat are they altered? If yes at what age?
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Where did you get this dog? Please be specific including the name and location of the: breeder or kennel, rescue, shelter, previous owner or friends info.
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How old was this dog when you brought them home?
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If you got this dog as a puppy what do you know about the dogs parents and littermates? How many in the litter? Did you meet both parents?
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Did the breeder use a puppy raising protocol? If yes, which one?
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Did you see the kennel or home where your puppy was born and raised?
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Yes
No
N/A
Where did you pick your puppy up? At the breeders location? Met somewhere else?
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Where did you pick up your puppy?
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At the breeders/caretakers location
Met the breeder/caretaker somewhere else
Picked up at a rescue or shelter
Some other option not listed
N/A
Was your puppy transported to you by a third party or flown to you?
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Age puppy was when first socialized outside the home environment?
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If this dog was obtained as an adolescent or adult dog (over 5 months of age) what info were you given about their prior history? Reason given up? Found as a stray? Any details about the dogs life prior to coming to live with you?
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What was the dogs behavior like when they first came home with you?
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How long have you had this dog?
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How is your dog's behavior currently with: Strangers, Visitors to your home, Children; does the dog want to move away from kids or interact with them, Other dogs; both on and off lead, Cats, Livestock, Wildlife? Please be as complete as possible, to the best of your knowledge, in describing your dogs behavior around ALL of the above.
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Describe your dogs personality.
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Describe your relationship with your dog.
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Was this dog house trained when you got them? If not, what potty training method did you use?
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Is this dog crate trained?
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Yes
No
How often do you use a crate? How long is your dog in their crate when the crate is used? Where is the crate located?
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Any formal training? Group class? Privates? Board and Train? If yes please provide which training program(s) your dog has had. Please include the trainer and/or facility where the training took place.
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What cues does your dog know?
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What cues does your dog respond to CORRECTLY at all times?
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How many dogs have you had?
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Do you feed commercial dry dog kibble?
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Yes
No
If yes, what brand do you feed? Why to you feed this brand?
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How much of this kibble is your dog fed daily? Do you feed once or twice daily? More often than twice daily? What time(s) of day is the dog fed?
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Is your dog free fed? (Food is available to the dog at all times)
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Yes
No
Do you feed a fresh, raw, natural or home prepared diet?
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Yes
No
If yes, what brand/style of diet or if home prepared what recipe or pre-mix do you use?
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List any supplements your dog receives.
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What type of treats does your dog enjoy? What treat is their favorite?
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Where is the dog fed? Why in this location? Who feeds the dog?
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How is the dog's appetite?
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Can you handle the food bowl when the dog is eating? Is there anyone who cannot?
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Any change in the diet recently? If yes, why?
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What type of toys does your dog enjoy? Plush, squeaky, chew bones, balls, something else?
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Are the toys available to your dog at all times?
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What are your dog's favorite activities? Do you play any games together?
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What is your dog's exercise routine? With whom, how much?
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Describe the families typical daily routine?
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Who is your Veterinarian/Vet Clinic?
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Has your dog been to see the Vet in the past six months? If yes, why?
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Please upload your dog's vaccine records. For dog 6 months of age and older include the date the last Parvo and last Distemper vaccines were given. We need the date the vaccine was given to your pet, NOT the due date that your vet clinic would like you back for a booster. Please include your dog's age appropriate rabies vaccine date as well. Attach the PROOF OF RABIES VACCINATION CERTIFICATE provided by the veterinarian who administered the rabies vaccine. This is the document required to license your pet. If your dog is a young puppy please provide each vaccine your pup has received to date and the date that vaccine was given. Proof of rabies vaccine is NOT required for puppies under 6 months of age but if your pup has received their first rabies vaccine already please include the Proof of Rabies vaccination document. You can upload multiple documents. You can save this application and return to it if you need to locate your pups vaccine records.
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Does your dog take a monthly preventative medication for fleas, ticks or Heartworm disease? If yes please provide the brand(s) of any products your dog receives. Are these medications given year round or seasonally/as needed?
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List any additional medications that your dog is currently taking.
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Please list any previous medical conditions and medications taken. How recently was the dog treated for these conditions?
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Can you handle your dogs entire body safely? Is there anyone who cannot? How does your dog behave when visiting the vet?
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Where does your dog spend their days? Where does your dog sleep at night?
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Does your dog have their own bed or beds? Where are the beds located?
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Is your dog allowed on the furniture or on your bed?
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Yes
No
Percentage of time your dog is indoors and outdoors? Should equal 100%
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Average amount of time/hours per day your dog is home alone? (you are at work or out of the home)
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Average amount of time/hours per day your dog is WITH another dog.
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How often/long is your dog left in alone in another part of the house when you are home?
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Does your dog follow you from room to room?
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Do you bathe your dog yourself? If yes, how often?
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Does your dog go to a professional groomer? If yes, how often?
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What is your dog's behavior during bathing/grooming?
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Has your dog been to the groomer recently? Any complaints or concerns from your groomer?
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Select all of the behaviors that apply to your dog.
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Noisy
Bites
Distructive
Pulls on lead/not leash trained
Chews
Doesn't come when called
Can't be left alone
Not potty trained
Barks
Jumps on people
Digs
Steals items
Excitable
Begs
Aggressive
Fights
Shy/Cautious
Runs away
Bolts through the door
Mouthy
Lunges and barks when on lead
Can't be left alone
Too attached to me
Anxious
Afraid or concerned about unknown people
Any other concerns not listed above?
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What concerns you most about your dog's behavior in general? What is the specific behavior you are most concerned with? (where might we want to begin?)
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How old was your dog when this behavior first started? When did you first notice the behavior?
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When is the most recent time you witnessed this behavior?
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Any specific circumstances that are likely to cause this behavior?
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What happens JUST prior to the behavior?
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What happens JUST after the behavior?
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What do you do when your dog behaves this way? How does your dog respond to what you do?
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How do you discipline/correct your dog? How does your dog react to the correction?
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Are you seeing any improvement in reducing the occurrence of the unwanted behavior with your efforts?
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Yes
No
Has your dog ever bitten or injured another dog, person or animal? Select all that apply.
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Dog
Adult
Child
Other animal
No known bites or injuries caused
Please provide details about any bites or injuries caused by this dog. What was the situation(s) that cause the dog to bite?
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What damage was done by the dog's bite? Check all that apply.
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Scratch to the skin/no open wound or bleeding
Broken skin/slight bleeding
Puncture wounds
Torn skin
Death to another animal
Was medical care required?
No known bites or injuries
How many bites has your dog caused?
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Does your dog react fearfully towards anything? What things are they afraid of? What does your dog do in these situations? What do YOU do?
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What changes have occurred in the following areas of your dog's life in the past six months?
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Newly adopted by me
Family member or animal companion died, moved, ill.
New baby
New pet added to family
Long term visitor/new roommate
Change in your work hours or job
Moved to a new home/town
Some other change int he family
Loss of some kind
Arguments with family members
None
Other
What do you like best about this dog?
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What are your long term goals for this dog?
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What do you want from your relationship with your dog?
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What do you expect from this training program?
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How did you hear about us?
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Please Select
Friend/Referral
Internet Search
Facebook
Veterinarian
Feed/Pet Store
Flyer/Poster
Groomer
Boarding or Day Care provider
Other
Please specify who or location of referral.
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Any additional information you'd like to share about you, your dog, your living situation or any details that might have an influence on your dog's behavior?
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