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 Date Picker Icon

Owner's Name

Dog's Name

Email

Phone

Us the drop down menu to describe your dog's reaction

Pet Your Dog

Hug Your Dog

Kiss Your Dog

Lift Your Dog

Stare at your dog

Bend over your dog

Reach towards your dog

Reach over your dog's head

Push on your dog's shoulders or back

Touch your dog's paws / feet

Touch your dog's tail

Touch your dog's face

You approach furniture / bed

Push / pull from furniture / bed

Disturb while resting / sleeping

Approach while eating

Touch while eating

Take food away while eating

Approach near treat / toy

Touch treat / toy

Take treat / toy

Approach water dish

Touch water dish

Take away water dish

Reaction to ANY object in your dog's possession

Try to put on collar / harness

Try to take off collar / harness

Try to put on leash

Try to take off leash

Restrain your dog by holding the collar / harness

Restrain your dog on leash

Bathe your dog

Towel dry your dog

Blow dry your dog

Brush / comb your dog

Trim nails

Any familiar adult enters the room

Any familiar child enters the room

Any unfamiliar adult enters the room

Any unfamiliar child enters the room

Any familiar adult enters your yard

Any familiar child enters your yard

Any unfamiliar adult enters your yard

Any unfamiliar child enters your yard

Any familiar adult leaves the room

Any familiar child leaves the room

Any unfamiliar adult leaves the room

Any unfamiliar child leaves the room

Any familiar adult moves or stands up quickly

Any familiar child moves or stands up quickly

Any unfamiliar adult moves or stands up quickly

Any unfamiliar child moves or stands up quickly

Any familiar animal enters your home

Any unfamiliar animal enters your home

Any familiar animal enters your yard

Any unfamiliar animal enters your yard

Response to babies / toddlers

When your dog is in the car at a drive-thru, tollbooth, gas station, etc.

Familiar adult approaches when you're with your dog on leash

Familiar child approaches when you're with your dog on leash

Familiar dog on leash approaches when you're with your dog on leash

Familiar adult approaches when you're with your dog off leash

Familiar child approaches when you're with your dog off leash

Familiar dog on leash approaches when you're with your dog off leash

Familiar dog off leash approaches when you're with your dog off leash

Unfamiliar adult approaches when you're with your dog when on leash

Unfamiliar child approaches when you're with your dog when on leash

Unfamiliar dog on leash approaches when you're with your dog on leash

Unfamiliar adult approaches when you're with your dog off leash

Unfamiliar child approaches when you're with your dog off leash

Unfamiliar dog on leash approaches when you're with your dog off leash

Unfamiliar dog off leash approaches when you're with your dog off leash

When your dog is inside the house / yard and sees people on the street

When your dog is inside the house / yard and sees dogs on the street

When your dog is inside the house / yard and sees cars on the street

When your dog is inside the house / yard and sees motorcycles on the street

When your dog is inside the house / yard and sees trucks on the street

When your dog is inside the house / yard and sees bicycles on the street

Your dog's reaction to delivery people, mail person, etc.

Your dog's reaction when on leash to vehicles

Your dog's reaction when on leash to bicycles, skate boards, scooters, etc.

Your dog's reaction when on leash to joggers, runners, etc.

Behavior at veterinary clinic

explain in detail

Behavior with groomer

explain in detail

Behavior with dog walker / pet sitter

explain in detail

Reaction when you verbally correct your dog

Reaction when you physically correct your dog

Reaction when you visually correct your dog, i.e. spray bottle, air horn, electric coller remote, etc.

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.