Behavior History Form
Christi Chapman, CDT
Form created by Janine Allen, CPDT-KA and used here with her permission
May I text you at the above phone number?
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Dog breed or “type”
Border Collie or herding mix
Dog’s approximate age or date of birth
Age of dog when adopted or purchased.
How did you obtain your dog? Please provide the name of the breeder, rescue or shelter if applicable.
Please list any medications your dog takes.
Does your dog have any medical conditions?
Epilepsy, Addison’s, Cushing’s, etc.
Please list any current or past medical conditions which may affect dog’s movement.
Surgeries, fractures, arthritis, etc.
Briefly describe your dog’s personality
How would your dog describe you?
How do you think your dog perceives you?
How does your dog get along with the other people in your home?
How does your dog get along with the other pets in your home?
How would your dog describe HIS daily life in your home?
Exciting? Calm? Boring? Purposeful? Chaotic? Frustrating?
What challenges are you having with your dog?
What do you think is the reason for your dog’s problem?
Describe the severity of the problem.
What age was your dog when the problem started.
Describe any changes in the home or your routine when the problem first started.
How often does the problem occur?
What has been done so far to try and correct the problem?
Describe any obedience training and how your dog responded.
What requests does your dog respond to?
Sit - always
Sit - usually
Sit - when my dog feels like it
Down - always
Down - usually
Down - when my dog feels like it
Walks on leash without pulling - always
Walks on leash without pulling - usually
Walks on leash without pulling - when my dog feels like it
Waits at door
Loads up in vehicle
Recall (comes when called) - always
Recall - usually
Recall - when my dog feels like it
Please indicate which of the following you have tried.
Gentle leader, halti, head halter
Electronic bark collar
Electronic training collar
Which collar or training listed above worked best with your dog?
DId you feel most in control using treats, electronic collar, clicker training, etc.?
Which of the following will cause your dog to become distracted and lose focus from you?
Birds or other animals
Noises or sounds
Bicycles, motorcycles, skateboards
Anything that moves
General fear of things in the environment
Reflections or lights
Is your dog crate trained?
In the past but no longer use it
Which family members have the most success in getting your dog to listen?
Why do you think they are successful? Why are others not so successful?
Nutrition, Exercise, and Play
Types/brands of food you feed and quantity.
Purina kibble, Nature’s Variety frozen raw, three cups twice a day, etc.
What is your dog’s feeding schedule?
Time of day, food left out all day, etc.
When do you give treats and how many per day?
What type/brand of treats do you give?
Do you give your dog chews such as hooves, horns, rawhide, antlers, bully sticks, greenies, etc.?
Describe the amount, type and frequency of exercise and play your dog engages in daily.
What is your dog’s reaction to being left alone?
How long does the reaction last?
The entire time he is alone
Just a few minutes
Off and on while alone
What is your dog’s reaction to your return?
Happy and excited
Happy and calm
Where does your dog sleep at night?
Loose in the house
Confined to a room
Confined to a crate or a pen
On my bed
Please check if your dog reacts aggressively or threateningly in any of the following situations:
While chewing on objects or playing with toys
During punishment or discipline
When people enter the home or yard
When dogs enter the home or yard
If you checked any of the boxes above, how do YOU react to your dog in this situation?
Give a command? Move dog to another location? Grab collar?
Please check if your dog dislikes any of the following:
Grooming or bathing
Cleaning or handling of ears
If you checked any of the boxes above, how do you react if your dog dislikes something?
Stop doing it? Give Treats? Keep doing it until your dog settles?
Has your dog ever bitten hard enough to break the skin or cause injury?
Yes, just once
Yes, more than once
No, just grazed the skin
My dog has snapped but not made contact
My dog has never bitten
When does your dog bark?
When left alone
When confined or crated
When someone is at the door
When meeting new dogs
When meeting new people
When in the car
When he wants to be let in or out
When he wants attention
When he sees something new
How do YOU react when your dog barks?
Say “no”? Leash your dog? Tell the dog to sit? Give treats?
Does your dog exhibit any of the following?
Urinates when excited
Fear of noises (thunder, cars, fireworks, etc.)
Shy or timid in new situations
Shy around new people
Shy around new dogs
Shy around men
Shy around children
If you checked any of the above boxes, how do YOU react to your dog in these situations?
Put dog on a leash? Move him away? Talk him through it?
How does your dog react to other animals or strangers ON your property?
How does your dog react to other animals or strangers OFF your property?
What are all of the wonderful and good things about your dog?
You obviously love your dog enough to fill out this long form so brag a bit!
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