Training Behavior Questionnaire

Dog Training and Behavior Questionnaire
OWNER INFORMATION
Name

First NameLast Name
Email
example@example.com
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
Reason for contacting us
New puppy, new dog, new rescue, general training, problem behavior, other, etc.
MAIN PRESENTING PROBLEM
What is the main reason/problem that you are inquiring about?
Background: When did you first notice tendencies of this problem behaviour?
Has there been a recent change in the behaviour? (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?
OTHER BEHAVIOUR 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 behaviour...
Please describe...
Any particular dog/dog dynamics that are relevant to your inquiry?
HEALTH AND VETERINARY INFORMATION
Veterinary Clinic
Past relevant medical or health conditions or important medical history (allergies, medication, injury, etc)? If yes, please describe...
Has dog had a full health check and vet has given all clear that there are no medical reasons causing the problem behaviours?
BACKGROUND INFORMATION
What are your reasons for having a dog?
Where did you get your dog from? Include name of breeder/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?
Is there any conflict in the home regarding your dog’s behaviour and training?
Environment around the home:
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.)
ROUTINES

Activities
Play: What types of play do you engage in with your dog? Please describe.
Exercise: What types of exercise does your dog regularly get?
Enrichment: What types of enrichment 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.
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?
Is your dog crate trained? Or have you tried crate training in the past?
Do you have any special rules and boundaries in your home, yard, etc.?
TRAINING
Have you been to any other professional trainers? Please describe for what for, training methods used, outcome of the training?
What are some of your training successes? Tricks count ;)
How do you let your dog know when they have done something “good”?
How do you let your dog know when they have done something “bad”?
What are some of your dog’s favourite rewards? Be specific.
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 rehomed.
6 - I have almost given up already and am seriously considering having my dog rehomed.
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:

Dog Training and Behavior Questionnaire

OWNER INFORMATION

DOG INFORMATION

MAIN PRESENTING PROBLEM

OTHER BEHAVIOUR PROBLEMS

HEALTH AND VETERINARY INFORMATION

BACKGROUND INFORMATION

HOUSEHOLD

DIET AND FEEDING

ROUTINES

ROUTINES

TRAINING