Pawsitive Behavior Questionaire

Your Name

First NameLast Name

Spouse/Partner Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

E-mail

Are there children under the age of 16 in the family or who visit?

If yes, please list ages

Dog's Name

Breed

Dog Age

Background

How long have you had your dog?

My dog is contained in yard by

If you adopted your dog, tell me about any background you have on him including name of adoption organization.

Why did you choose this particular dog?

Physical and Medical Issues

Vet's Name

Vets's Phone

Area CodePhone Number

When was last vaccination & exam?

Is your dog spayed/neutered?

List any medical problems, allergies, & medications

Training

Who does or is responsible for training your dog?

Has your dog had any previous training? (describe familiar cues, training methods and who did the training)

Describe how you reward your dog for good behavior.

Describe what you do with your dog for unwanted behavior and give an example of the circumstances under which you might do so.

Describe your training goals for your dog.

What type of exercise does your dog receive & how often?

What is your dog's favorite treat?

What is your dog's favorite toy?

What is your dog's favorite activity?

Behavior Issues

What behaviors would you like to change?

Under what specific circumstances does the behavior(s) occur?

Has the frequency of the behavior

Has the intensity of the behavior(s)

Handling Issues

At vet or groomer

Activities you or family member cannot do

My dog is less accepting of touch on

My dog's reaction is

Resource Guarding Issues

What items does your dog guard

When your dog has a valued item, what is his reaction if someone approaches?

This behavior started when

This behavior is more intense

How long has your dog be guarding?

What have you done to address this issue so far? Please be specific.

What is your dog's reaction to strangers?

My dog has this reaction when

My dog does not like

This behavior has become

In detail, what has been done to address the issue so far? Describe results.

Describe in detail circumstance if a bite has happened. Who, when, where, how, seriousness of bite.

Reactivity to Other Dogs

What is your dog's reaction to another dog?

My dog has this reaction when

This behavior has become

This behavior started when

In detail, what has been done to address the issue so far? Describe results.

If your dog has attacked another dog, please describe in detail the circumstances of the fight.

Please read and sign the following Training Agreement

Although precautions are taken, the risk to have contact with individuals who have been exposed to Covid-19 does exist and it is impossible to eliminate the risk that I or family member could be exposed to and/or become infected through contact with or close proximity with an individual with this disease.

The owner agrees to be responsible for the conduct of his/her dog while participating with Pawsitive Dog Training on location. By signing this release he/she agrees to hold harmless and release Pawsitive Dog Training, the instructor in charge and the home/property owner from any and all liability expense whatsoever, due to damages, injuries or loss to owner or others arising from participation.

Date

Signature

Pawsitive Dog Behavior Questionaire

Reactivity to People