Behavior Questionnaire
Owner Information
Your Name:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Format: (000) 000-0000.
Email:
example@example.com
Household Information
Family members living in the home (check all that apply):
Husband
Wife
Child 0-2
Child 2-5
Child 5-8
Child 8-12
Child 12-16
Child 16+
Other:
List all animals/pets in the household (include species & names):
Dog Information
Dog's Name:
Sex:
Male
Female
Breed:
Date of Birth:
-
Month
-
Day
Year
Date
How many months have you had this dog?
Nutrition
Current dog food brand(s):
Treats (brands, amounts, schedule):
Anything else the dog eats (table scraps, supplements, etc.)?
Background
If adopted, please provide any known background information about the dog:
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Why did you choose this particular dog?
Veterinary & Medical History
Veterinarian's Name:
Veterinarian's Phone:
Format: (000) 000-0000.
Website (if applicable):
Date of last vaccination & exam:
Has this dog been neutered/spayed?
Yes
No
If yes, age in months when neutered/spayed: months
Reason for neutering/spaying:
Any behavioral changes after neutering/spaying?
Has this dog been bred?
Yes
No
If yes, any behavioral changes after breeding?
If not yet bred, do you plan to breed this dog?
Yes
No
List any current or past medical problems, allergies, and medications:
How did you hear about K9 Advantage?
Word of mouth
Online
Other
Daily Life & Management
How do you feed your dog?
Free feed (food always available)
Set times (pick up food if not eaten)
How many times a day do you feed?
1
2
3
Where does your dog sleep?
What percentage of time is your dog inside?
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How does your dog behave in the vehicle?
Calm
Excited
Nervous
Paces
Barks
Gets sick
Number of walks per day:
Average length of each walk:
minutes
Number of play sessions per day:
Number of training sessions per day:
When you leave the dog alone, where is he/she kept?
Free in house
Free outdoors
Behind gate/door in house
Indoor Kennel/run
Outdoor kennel/run
Crate indoors
Crate outdoors/garage
Other
How long does your dog spend alone on a typical day?
hours
Training History & Interests
Previous obedience/training history:
No school - trained yourself
Puppy kindergarten
Group lessons - basic
Group lessons - advanced
Private trainer at home
Private trainer - board & train
Agility
Flyball
Other
Age when training/lessons started:
months
How did the dog perform in previous training?
Type of training currently interested in:
Private Sessions
Complete Obedience
Drop-in classes
Package training
Board & Train
Behavior management
Training & Behavior Goals
Describe your main training goals for this dog:
Who is primarily responsible for training the dog?
How do you reward your dog for good behavior?
Describe what you do when the dog shows unwanted behavior. Provide a specific example of the circumstances:
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Do you use a crate?
Yes
No
What is your dog's favorite toy?
What is your dog's favorite activity?
Behaviors You Would Like to Change (check all that apply)
Jumping on people
Running away
Stealing
Over excited
Gets on furniture
Excessive chewing
Nipping
Does not listen
Digging
Out-of-control barking
Counter surfing
Crate training problems
Playing rough
Problems housetraining
Not coming when called
Pulling on walks
Begging at table
Aggressive towards people
Aggressive towards dogs
Fearful/shyness
Has the frequency increased/decreased/remained the same?
Has the intensity increased/decreased/remained the same?
Under what specific circumstances do these behaviors occur?
Handling / Touch Sensitivity Issues Activities family members cannot comfortably do with the dog (check all that apply):
Pat top of head
Reach for dog
Lean over dog
Step on dog
Pick up dog
Push off couch/bed
Bathe dog
Brush dog
Pull fur (including tail)
Check teeth
Check/clean ears
Clip nails
Grab or pull on collar
Attach leash to collar
Hug
Restrain
At the vet or groomer:
Growls (no bite)
Has to be muzzled
Shy/fearful
Lunges
Over-excited
No growl, will bite
Bite has broken skin
Not a problem
Areas where the dog is less accepting of touch (check all that apply):
Feet
Face
Ears
Tail
Mouth
Top of head
Typical reaction to unwanted touch:
Pulls away
Growls
Snarls
Mouths
Warning nips
Serious bite
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Resource Guarding Issues Items guarded (check all that apply):
Treats
Bones/Rawhides
All possessions
Food bowl
Toys
Me or family member
Not a problem
Typical reaction:
Runs away with item
Growls
Shows teeth
Warning nips
Serious bite
This behavior is more intense:
Feeding area
On couch
In crate
Under table
Back yard
In vehicle
Other
This behavior started:
In the last couple of weeks
1-6 months ago
6 months-1 year
Over a year ago
When a valued item is present, and someone approaches, the dog:
Stiffens
Freezes
Gets excited
Stares
Growls
Air snaps
Will drop/give eventually
Lunges
Serious
Runs away
Not a problem
Other
How long has the dog been guarding?
Since a puppy
Since 6 months or older
Just started recently
Other
What have you done so far to address resource guarding? (be specific)
Reaction to People / Strangers Typical reaction to strangers (check all that apply):
Over- excited
Barks
Hair raises on back
Growls
Snarls
Lunges
Stares
Backs up
Air snaps
Hides behind you
Runs away & hides
Not a problem
Other
This reaction occurs when:
Someone comes in yard/house
Meeting on walks
Doorbell/knock
Person turns & walks away
People walking past yard/house
Other
This behavior has become:
More frequent
More intense
Stayed the same
Dog is particularly uncomfortable with:
Kids
Teenagers
Men
Women
Hats
Elderly
Sunglasses
Purses/packages
Facial hair
Being petted
Loud noises
Thunder
Gesturing
Fast movements
Coming toward him
Family member
What has been done to address this issue so far? Describe results:
Back
Next
If the dog has bitten a person, describe in detail (who, when, where, how, severity):
Reaction to Other Dogs Typical reaction to another dog (check all that apply):
Over-excited
Barks
Hair raises on back
Growls
Shows teeth
Lunges
Stares
Backs up
Stiffens
Hides behind you
Runs away & hides
Not a problem
This reaction occurs when:
Other dog comes in yard/house
Meeting on walks
At dog park
Other dog turns & walks away
Other dog walking past yard/house
Only with certain dogs
On leash
Off leash
This behavior has become:
More frequent
More intense
Stayed the same
This behavior started when:
Young puppy
6 months-1 year
Adult
Just started recently
What has been done to address this issue so far? Describe results:
If the dog has attacked another dog, describe the circumstances in detail:
Thank you for completing this questionnaire. Your detailed responses help create a tailored behavior and training plan.
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