Behavioral Eval & Private Form

Behavioral Eval & Private Form
Client Name*

First NameLast Name
Date of Eval*

MonthDayYear
NO2345
MaleFemale
1 - Dog(s) Name, Current Age*
1 - Dog Breed(s)
MaleFemale
2 - Dog(s) Name, Current Age*
2 - Dog Breed(s)
MaleFemale
3 - Dog(s) Name, Current Age*
3 - Dog Breed(s)
MaleFemale
4 - Dog(s) Name, Current Age*
4 - Dog Breed(s)
MaleFemale
5 - Dog(s) Name, Current Age*
5 - Dog Breed(s)
YesNo
K9UClient HomeOther
Age of dog(s) when acquired
When did issue start
Client Reported Issues*
OwnerFriendsStrangersMale DogsFemale DogsKids
YESNO
Name of Medication:
How long has your dog been on medication?
YesNo

OwnerFriendsStrangersMale DogsFemale DogsKids
Evaluation Comments*
FearDefenceTerritorialOverprotectiveResource GuardingPredatoryDogFoodToyPeopleRedirectedDominancePossesiveMaternalAlpha Struggle, HumansAlpha Struggle, DogsPainNuisanceLacks Social Skills: PeopleLacks Social Skills: DogsClass Placement

Rate Aggression:

	1	2	3	4	5	6	7	8	9	10

1 is Lassie, 10 is Cujo

PeopleChildrenDogs (Sm)Dogs (Lg)
YesNo
1:1 Strict OBGroup Behav1:1 BehavHome BehavPrivate OBGroup OBBoarding SchoolDay-Camp
Behavior Plan Comments*
How much $$ Charged TODAY*
Dollars
Eval Completed By*

First NameLast Name
Behavior Class / Private Notes

Behavior Group Class Notes or Behavior Private notes (if applicable)
FearDefenceTerritorialOverprotectiveResource GuardingPredatoryDogFoodToyPeopleRedirectedDominancePossesiveMaternal
Date of Class / Private

MonthDayYear
Number of Encounters
Spray BottleSpray Bottle w/ VinagerFlat CollarSlip CollarSm Metal PinchMd Metal PinchLg Metal PinchOther
Session Status & Response to training
Trainer Name

First NameLast Name
Date of Class / Private

MonthDayYear
Number of Encounters
Date of Class / Private

MonthDayYear
Number of Encounters
Spray BottleSpray Bottle w/ VinagerFlat CollarSlip CollarSm Metal PinchMd Metal PinchLg Metal PinchOther
Session Status & Response to training
Trainer Name

First NameLast Name
Date of Class / Private

MonthDayYear
Number of Encounters
Spray BottleSpray Bottle w/ VinagerFlat CollarSlip CollarSm Metal PinchMd Metal PinchLg Metal PinchOther
Session Status & Response to training
Trainer Name

First NameLast Name
Date of Class / Private

MonthDayYear
Number of Encounters
Spray BottleSpray Bottle w/ VinagerFlat CollarSlip CollarSm Metal PinchMd Metal PinchLg Metal PinchOther
Session Status & Response to training
Trainer Name

First NameLast Name
Date of Class / Private

MonthDayYear
Number of Encounters
Spray BottleSpray Bottle w/ VinagerFlat CollarSlip CollarSm Metal PinchMd Metal PinchLg Metal PinchOther
Session Status & Response to training
Trainer Name

First NameLast Name
Should be Empty:

Rows	1	2	3	4	5
Favorite dog; Wife
Favorite dog: Husband
In the door first
Out the door first
Who greets at door first
Food dominant
Dominant over dogs (head, body, posture)
Dominance over toys
Dominant position over Humans
Dominant position over DOGS
Chasing in Play, who leads?
Starts Play
Ends Play
Starts fight sessions
Walks in front
Allowed on BED
Allowed on couch/chair
Who Humps HUMANS
Who Humps DOGS
Groomed by other dogs
Who Marks over each-other

Behavioral Eval & Private Form

Behavior Class / Private Notes