| General Information |
| Full Name: |
|
Email:
(required) |
|
| Date: |
|
| Phone Number: |
|
| Dog's Name: |
|
| Breed: |
|
| Age: |
|
| Sex: |
|
| Neutered/Spayed: |
|
Describe the main behavior problem:
Be sure to include how frequently the problem occurs. |
|
Additional Problems:
Be sure to include how frequently the problem occurs. |
|
|
| Chronology of the Behavior |
| When did you first notice the main problem? |
|
| When did it first become a serious concern? |
|
| In what general circumstances does the dog misbehave? |
|
| Has this problem changed in frequency? Please describe. |
|
| Has this problem changed in intensity? Please describe. |
|
| Has this problem otherwise changed? |
|
| Describe several examples in some detail: |
|
| What have you done so far to try to correct the problem? |
|
| How do you discipline your dog for this and other misbehavior? |
|
|
| Home Environment |
| How long is the dog left alone? |
|
| What other animals are in the house? |
|
| In what sequence were the animals obtained? |
|
What is your dog's relationship to the other animals?
(i.e., fearful, hostile, friendly) |
|
| What type of area do you live in? |
|
| Have you moved since acquiring the dog? |
|
Has your household changed since acquiring the dog? Please explain.
(i.e., has anyone moved in or out) |
|
|
| Dog's Background |
| Why did you decide to get a dog? |
|
| Why did you choose this breed? |
|
| Where did you get this dog? |
|
| Have you owned dogs before? |
|
| Describe your dog's behavior as a puppy: |
|
Has this dog had other owners?
If yes, how many? |
|
| Why was the dog given up? |
|
| At what age was your dog spayed/neutered? |
|
| Were there any behavior changes after neutering? |
|
| Is your dog on any medication? Please describe: |
|
|
| Diet and Feeding |
| What do you feed your dog? |
|
| Has your dog's appetite changed? |
|
| How much do you feed? |
|
| Meal times: |
|
| What is your dog's favorite treat? |
|
| Is your dog food-aggressive? |
|
|
| Daily Schedule & Routine |
| Please describe a typical 24 hour day in your dog's life: |
|
| How does dog behave with familiar visitors? |
|
| How does dog behave with unfamiliar visitors? |
|
| How do you exercise your dog? |
|
| Is the dog free in a fenced yard? |
|
| Is the dog tied outside? |
|
| Does the dog run free? |
|
| How do you play with your dog? |
|
| What toys does your dog have? |
|
| Is your dog 100% housetrained? |
|
| Where does your dog sleep at night? |
|
| Is dog crated when you are away? |
|
| Where is your dog when you have guests? |
|
| How does your dog behave when you leave the house? |
|
| How does your dog behave when you return? |
|
|
| Obedience Training |
| What basic obedience has your dog had? |
|
| What types of training tools do you use (if any, check as many as apply) |
|
| How old was the dog when he/she started obedience training? |
|
| Who in the family is the primary trainer? |
|
| Does your dog have any awards or titles? |
|
| Check if your dog participated in: |
|
| What percent of the time does your dog obey the following commands? |
|
| Does your dog jump on people without permission? |
|
| Does your dog paw at you or others? |
|
| Does your dog lick you? |
|
| Does your dog mount people? |
|
| If yes whom does the dog mount? |
|
| Does your dog mount other dogs? |
|
| Does your dog ever bark at you? |
|
| If so, when? Please describe: |
|
| Does your dog bark at other times? Please explain: |
|
| What is the dog's activity level in general? |
|
|
| Aggression Screen |
** Please skip down to the "Submit Form" button if your dog is not aggressive **
Note: You MUST click on "Submit Form" either way or we won't receive your answers. |
| Attacks are sudden and surprising |
|
| Episodes appear unprovoked |
|
| The dog is abruptly docile after an episode |
|
| The dog appears "sorry" afterwards |
|
| The dog appears disoriented
afterwards |
|
| Episodes are associated with a "glazed" or "absent" expression |
|
| I can usually tell what will set off my dog |
|
| The aggressive behavior is new and uncharacteristic |
|
| Has your dog bitten and broken skin? |
|
| Number of times (broke skin) |
|
| Total numberr of all bites (broke skin or not) |
|
| Total number of episodes of aggression(inc. growling, snarling) |
|
| Describe typical episode (eg. does dog growl, lunge or bite, and in what circumstance?) |
|
| If the dog is in the above situation 10 times, in how many of those times is aggression seen (eg. all=100%, just one=10%, etc.)? |
|
| What parts of the body has the dog bitten and how severe were the injuries? |
|
| Who is/are the target(s) of aggression? |
|
| Did your dog bite aggressively as a puppy? |
|
| How old waas the dog when he/she first showed signs of aggressioon? |
|
| |
|
| | |
| |
|