Aggression Screen

Please take the time to accurately complete this form. It will assist me in assessing your dog's aggressive / reactive behaviors and in developing a behavior modification plan to change these behaviors.

Date

- Month - Day Year

Owner's Name

Dog's Name

Email

Phone

For each behavior, please indicate whether your dog: Growls; Bares teeth; Air snaps; Bites; No reaction; N/A (not applicable). Include any information that you think is relevant to the question.

Pet your dog

Hug your dog

Kiss your dog

Lift your dog

You approach the furniture / bed

Push / pull off furniture / bed

Disturb while resting / sleeping

Approach while eating

Touch while eating

Take dog food away

For each behavior, please indicate whether your dog: Growls; Bares teeth; Air snaps; Bites; No reaction; N/A (not applicable). Include any information that you think is relevant to the question.

Take human food away

Take water dish away

Take bone away

Take bully stick / rawhide away

Take toy away

You approach when your dog has any object

Verbally punish- describe how you verbally punish and your dog's reaction

Physically punish- describe how you physically punish and your dog's reaction

Visually threaten your dog (hold up a spray bottle, air horn, etc.)

For each behavior, please indicate whether your dog: Growls; Bares teeth; Air snaps; Bites; No reaction; N/A (not applicable). Include any information that you think is relevant to the question.

Stare at your dog

Bend over your dog

Reach toward your dog

Reach over your dog's head

Push on your dog's shoulders or back

You or someone enters the room

You or someone leaves the room

You or someone stands up quickly

For each behavior, please indicate whether your dog: Growls; Bares teeth; Air snaps; Bites; No reaction; N/A (not applicable). Include any information that you think is relevant to the question.

Try to put on collar

Try to take off collar

Try to put on leash

Try to take off leash

Try and put on harness

Restrain your dog on leash

Try to take off harness

Restrain your dog by the collar

For each behavior, please indicate whether your dog: Growls; Bares teeth; Air snaps; Bites; No reaction; N/A (not applicable). Include any information that you think is relevant to the question.

Bathe your dog

Towel dry your dog

Blow dry your dog

Brush / comb your dog

Trim nails

Behavior at veterinary clinic

Behavior with groomer

Behavior with pet sitter / dog walker

For each behavior, please indicate whether your dog: Growls; Bares teeth; Air snaps; Bites; No reaction; N/A (not applicable). Include any information that you think is relevant to the question.

Unfamiliar adult enters your home

Familiar adult enters your home

Unfamiliar child enters your home

Familiar child enters your home

Unfamiliar adult enters your yard

Familiar adult enters your yard

Unfamiliar child enters your yard

Familiar child enters your yard

Unfamiliar animal enters your home

Familiar animal enters your home

Unfamiliar animal enters your yard

Familiar animal enters your yard

For each behavior, please indicate whether your dog: Growls; Bares teeth; Air snaps; Bites; No reaction; N/A (not applicable). Include any information that you think is relevant to the question.

Response to babies / toddlers

Your dog in car at tollbooth, drive thru, gas station, etc.

Unfamiliar adult approaches you when your dog is on leash

Familiar adult approaches you while your dog is on leash

Unfamiliar child approaches you when your dog is on leash

Familiar child approaches you when your dog is on leash

Your dog inside your home and sees people outside

Your dog inside your home and sees dogs / animals outside

Response to other dogs when your dog is on leash

Response to other dogs when your dog is off leash

I know I've asked you many questions and I thank you for taking the time to complete this form. You've demonstrated a commitment to helping your dog overcome the challenges it faces and to be your dog's advocate for a better life. Your dog thanks you for being the partner it needs.