Behavioral Evaluation Form
Client Name
*
First Name
Last Name
Date of Eval
*
-
Month
-
Day
Year
Date Picker Icon
Multiple Dogs?
NO
2
3
4
5
1 - Gender
Male
Female
1 - Dog(s) Name, Current Age
*
1 - Dog Breed(s)
2 - Gender
Male
Female
2 - Dog(s) Name, Current Age
*
2 - Dog Breed(s)
3 - Gender
Male
Female
3 - Dog(s) Name, Current Age
*
3 - Dog Breed(s)
4 - Gender
Male
Female
4 - Dog(s) Name, Current Age
*
4 - Dog Breed(s)
5 - Gender
Male
Female
5 - Dog(s) Name, Current Age
*
5 - Dog Breed(s)
Spay or Neutered?
Yes
No
Evaluation Done at?
K9U
Client Home
Other
Age of dog(s) when acquired
When did issue start
Client Reported Issues
*
Dog has issues with:
Owner
Friends
Strangers
Male Dogs
Female Dogs
Kids
Is your dog on any medication?
YES
NO
Name of Medication:
How long has your dog been on medication?
Alpha Struggle?
Yes
No
Alpha Struggle Dominance Chart
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
Assault during eval:
Owner
Friends
Strangers
Male Dogs
Female Dogs
Kids
Evaluation Comments
*
Aggression Assessment:
Fear
Defence
Territorial
Overprotective
Resource Guarding
Predatory
Dog
Food
Toy
People
Redirected
Dominance
Possesive
Maternal
Alpha Struggle, Humans
Alpha Struggle, Dogs
Pain
Nuisance
Lacks Social Skills: People
Lacks Social Skills: Dogs
Class Placement
Rate Aggression:
1
2
3
4
5
6
7
8
9
10
Lassie
Cujo
1 is Lassie, 10 is Cujo
Assessed Aggression is Towards:
People
Children
Dogs (Sm)
Dogs (Lg)
Is the dog used to being crated?
Yes
No
Behavior Plan:
1:1 Strict OB
Group Behav
1:1 Behav
Home Behav
Private OB
Group OB
Boarding School
Day-Camp
Behavior Plan Comments
*
How much $$ Charged TODAY
*
Dollars
Eval Completed By
*
First Name
Last Name
Submit Eval
Behavior Class / Private Notes
Behavior Group Class Notes or Behavior Private notes (if applicable)
Aggression Assessment:
Fear
Defence
Territorial
Overprotective
Resource Guarding
Predatory
Dog
Food
Toy
People
Redirected
Dominance
Possesive
Maternal
Date of Class / Private
-
Month
-
Day
Year
Date Picker Icon
Number of Encounters
Type of Interruption
Spray Bottle
Spray Bottle w/ Vinager
Flat Collar
Slip Collar
Sm Metal Pinch
Md Metal Pinch
Lg Metal Pinch
Other
Session Status & Response to training
Trainer Name
First Name
Last Name
Submit Class / Private - 1
Date of Class / Private
-
Month
-
Day
Year
Date Picker Icon
Number of Encounters
Date of Class / Private
-
Month
-
Day
Year
Date Picker Icon
Number of Encounters
Type of Interruption
Spray Bottle
Spray Bottle w/ Vinager
Flat Collar
Slip Collar
Sm Metal Pinch
Md Metal Pinch
Lg Metal Pinch
Other
Session Status & Response to training
Trainer Name
First Name
Last Name
Submit Class / Private - 2
Date of Class / Private
-
Month
-
Day
Year
Date Picker Icon
Number of Encounters
Type of Interruption
Spray Bottle
Spray Bottle w/ Vinager
Flat Collar
Slip Collar
Sm Metal Pinch
Md Metal Pinch
Lg Metal Pinch
Other
Session Status & Response to training
Trainer Name
First Name
Last Name
Submit Class / Private - 3
Date of Class / Private
-
Month
-
Day
Year
Date Picker Icon
Number of Encounters
Type of Interruption
Spray Bottle
Spray Bottle w/ Vinager
Flat Collar
Slip Collar
Sm Metal Pinch
Md Metal Pinch
Lg Metal Pinch
Other
Session Status & Response to training
Trainer Name
First Name
Last Name
Submit Class / Private - 4
Date of Class / Private
-
Month
-
Day
Year
Date Picker Icon
Number of Encounters
Type of Interruption
Spray Bottle
Spray Bottle w/ Vinager
Flat Collar
Slip Collar
Sm Metal Pinch
Md Metal Pinch
Lg Metal Pinch
Other
Session Status & Response to training
Trainer Name
First Name
Last Name
Submit Class / Private - 5
Should be Empty: