Dog Behavior History Form
Your First Name
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Your Last Name
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E-mail
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Phone Number
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Area Code
Phone Number
Address
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Street Address
Mailing Address
City
State / Province
Postal / Zip Code
Pet name
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Pet Breed
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Color
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Weight
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Pet's Date of Birth
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Month
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Day
Year
Date Picker Icon
Sex
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Male
Female
Spayed
Neutered
What age did you obtain your pet?
Where did you get your pet?
Was your pet initially:
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Outgoing
Shy
Describe your home and property
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Do you have high speed internet?
Yes
No
Who is your veterinarian?
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Vet phone
When was your pet's last vet visit?
List any medications from the past 6 months to current. Mark current medications with an *
Summarize your pet's medical history
Do we have your permission to contact your veterinarian?
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Yes
No
Exploring your pet's life.
Describe your exercise routine with the pet
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What is your pet's favorite treat?
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What brand of food do you feed?
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Please list the toys your pet has
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Is your pet crated?
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Yes
No
What skills is your pet proficient with?
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What tools have you used:
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Standard Collar
Choke Collar
Prong Collar
Remote Collar
Clicker
Head Harness
Body Harness
Please list any training tool you are opposed to:
Please explain your opposition to the tools you listed
Lets explore the main issues...
At what age did you first notice the issue?
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Please describe the most recent event IN DETAIL
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What was the dog's behavior immediately following the event?
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What was your response?
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What seemed to trigger the event?
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Please describe any other past events, in detail
How often does this behavior occur?
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Has there been a recent increase in the behavior?
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Yes
No
Describe the pet's behavior upon your returning home
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Have there been any changes in the home/family recently? Please describe
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List any suggestions provided by other professionals, if applicable
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Have you considered re-homing the pet?
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Yes
No
Please describe your ideal lifestyle with your dog. This is not desired skills, but rather the life you would like as a result of the skills.
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Please provide any other information you feel might be helpful
What would you like to see at the end of your behavior work?
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Are there other decision makers other than yourself? If so, what is their name?
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To eliminate " I have to talk to my...before making a decision"
Have you reviewed our programs / tuitions / durations on our website?
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Yes
No
How did you hear about us?
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Please be specific
After submitting this form, you will be given choices for a date and time to schedule a discovery appointment with us. Submissions without a scheduled session will be discarded.
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