Pawsitive Behavior Questionaire

Pawsitive Dog Behavior Questionaire
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Spouse/Partner Name

First NameLast Name
Are there children under the age of 16 in the family or who visit?*

YesNo
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*

chain link fenceunderground fencingtied outkennelon leashnot contained at all
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?*

YesNo
List any medical problems, allergies, & medications
Training
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.*
Who does or is responsible for training your dog?
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?*

Jumping on peopleExcessive chewingOut of control barkingProblems potty trainingChasingNippingCounter surfingNot coming when calledRunning awayDoes not listenProblems crate trainingPulling on walksStealingNippingDiggingPlaying roughBegging at tableGets on furnitureOther
Under what specific circumstances does the behavior(s) occur?*
Has the frequency of the behavior *

IncreasedDecreasedRemained the same
Has the intensity of the behavior(s) *

IncreasedDecreasedRemained the same
Handling Issues
At vet or groomer*

growls no bitelungesno growl, will bitebite has broken skinhas to be muzzlednot a problem
Activities you or family member cannot do*

Pat top of headReach for dogLean over dogStep on dogPick up dogPush off couch or bedBathe dogBrush dogPull fur including tailCheck teethCheck/clean earsclip nailsgrab or pull on collarattach leash to collarhugrestrainno problem
My dog is less accepting of touch on

feetfaceearstailmouth
My dog's reaction is

pulls awaygrowlssnarlswarning nipsserious bite
Resource Guarding Issues
What items does your dog guard*

food bowltoystreatsbones/rawhidesalll possessionsme or family membernot a problem
My dog's reaction is

runs away with itemgrowlsshows teethwarning nipsserious bite
This behavior started when

young puppy5 month or olderadultjust started recently
This behavior is more intense

feeding areaon couchin crateunder tableback yardother
When your dog has a valued item, what is his reaction if someone approaches?*

stiffening of bodyfreezesstaresgrowlsair snappinglungesserious biteruns awaywill drop/give eventuallynot a problem
How long has your dog be guarding?

since a puppywhen 5 months or olderjust started recently
What have you done to address this issue so far? Please be specific.
Reactivity to People
What is your dog's reaction to strangers?*

barkshair raises on backgrowlssnarlslunges at personstares at personbacks upair snappinghides behind youruns away & hidesnot a problem
My dog has this reaction when

someone comes in yard/housemeeting on walksdoorbell or knock on doorpeople walking past yard/houseonly when person enters houseperson goes to petperson turns & walks awayother
My dog does not like

kidsteenagersmenwomenelderlyhatssunglassespurses/packagesfacial hairbeing pettedgesturingfast movementscoming toward himfamily member
This behavior has become

more frequentmore intensestayed the same
In detail, what has been done to address the issue so far? Describe results.
Describe in detail circumstance of bite. Who, when, where, how, seriousness of bite.
Reactivity to Other Dogs
What is your dog's reaction to another dog?*

barkshair raises on backgrowlsshows teethlunges at dogstares at dogbacks upstiffening of bodyhides behind youruns away & hidesnot a problem
My dog has this reaction when

other dog comes in yard/housemeeting other dog on walksat the dog parkother dog walking past yard/houseonly with certain dogsother dog turns & walks awayon leashoff leash
This behavior has become

more frequentmore intensestayed the same
This behavior started when

young puppy5 month or olderadultjust started recently
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*

MonthDayYear
Date
Signature*
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Pawsitive Dog Behavior Questionaire

Reactivity to People