Training Behavior Questionnaire

OWNER INFORMATION
Name

First NameLast Name
Primary Email
example@example.com
Please advise if you have any disability, health or physical issue we should be aware of that would affect your ability to participate in training your dog.
DOG INFORMATION

If you are inquiring about more than one dog please complete an additional form.
Name
Current age of your dog
Breed
REASON FOR CONTACTING
Ie:
New puppy/new dog/new rescue
General training and manners
Problem behaviour - Why now?
- New behaviour
- Recent increase/incident/etc.
- Not resolving. Time to get help
- Situational change
- Other...
Please describe:
PRESENTING PROBLEM
What is the main reason/problem that you are inquiring about?
Has there been a recent change in the behaviour? (More frequent? More intense? Different circumstances?)
What have you done so far to address this problem? With what effect?
OTHER BEHAVIOUR PROBLEMS
Check all that apply and are a concern to you and give details.

AnxietyAggression - PeopleAggression - DogsAggression - Other animalsBarking, vocalizing excessivelyChasing moving objects (bike, vehicle, etc.)Chasing people or dogsCounter SurfingDemanding, attention seekingDestructive (chewing, scratching, etc.)DiggingDoor dashingEscaping (Fence jumping, etc.)FearHouse soilingJumping upRunning offSeparation distressStealing food, objectsUnruly (Jumping, mouthing, etc.)Other: humping, eating non food objects, compulsive behaviour...
Please describe...
How old was your dog when you got him/her?
HOUSEHOLD
Relevant changes or dynamics that may affect your dog:
Is there any conflict in the home regarding your dog’s behaviour and training?
DIET AND FEEDING
How food motivated is your dog? 1 - 10 (finicky ... voracious)
Please describe your dog’s mealtime. (Where, when, how often, who feeds, special routine, etc.)
Does your dog guard their regular meal against humans? (growl, snap, etc.)
Equipment/Tools

ACTIVITIES
Walking gear: Please describe: What kind of leash, collar or harness do you use now? Prong collar? Ecollar?
Muzzle: Does your dog use a muzzle for any reason?
ROUTINES

HOME ALONE
Is your dog content in a crate?
ROUTINES

HOME TOGETHER
Is your dog allowed on furniture?

YesNoWith permissionType option 4
ROUTINES

VISITORS
How does your dog react when unfamiliar people come to your home? Please describe: (Bark, jump, mouth, calm, etc.)
Is your dog fully housetrained?
TRAINING
How do you let your dog know when they have done something “good”?
What types of corrections have you tried or currently use? (interrupt, redirect, time out, verbal reprimand, physical reprimand, scruff, muzzle grab, alpha roll, squirt bottle, throw chain, shake can, choke collar, pinch collar, citronella collar, electronic/stimulation/shock collar, etc.)
Has your dog participated in any professional training before? If yes, please describe.
SOCIABILITY

INTERACTIONS WITH DOGS
How would you describe your dog’s sociability with other dogs in general?

dog socialdog tolerantdog selectivedog defensivedog aggressive
Does your dog attend doggie day care, dog walker or a boarding facility?
SOCIABILITY

INTERACTIONS WITH PEOPLE
Have they bitten and bruised or broken skin?
In what situations does your dog tend to act aggressively towards people?
When people approach their food, dish, bone, etc.?
When people approach their possessions, toy, etc.?
When people approach their bed, couch, etc.?
Is there anything else that you would like us to know about your situation or your dog?
RATE FROM 1 – 6

1 - I would like to learn more but the problem is not serious
2 - I would like to change problem but it is not serious
3 - The problem is serious and I would like to change it, but if it remains unchanged that’s all right.
4 - The problem is very serious and I would like to change it, but if it remains unchanged I will keep my dog.
5 - The problem is very serious and I would like to change it; if it remains unchanged I will have my dog euthanized or give him/her up.
6 - I have almost given up already and am seriously considering having my dog euthanized or giving him/her up.
Please rate:
How much time per day total are you able to dedicate to training? (in 10-minute increments. ie: total 1 hour)
Thank you for taking the time to complete this form. Consider recording any incidents in chronological order and recording any new information and share with us before or on the day of our next session.
Should be Empty:

OWNER INFORMATION

DOG INFORMATION

REASON FOR CONTACTING

PRESENTING PROBLEM

OTHER BEHAVIOUR PROBLEMS

HOUSEHOLD

DIET AND FEEDING

Equipment/Tools

ROUTINES

ROUTINES

ROUTINES

TRAINING

SOCIABILITY

SOCIABILITY