Behavior Questionnaire Your Information: Primary Owner/Contact:*FirstLast Address:* Street Address City State / Province / Region Postal / Zip Code Day Phone: Area Code - Phone Number Eve Phone: Area Code - Phone Number Email:* Confirm Email:* How did you hear about us? Names and ages of all humans living in the house: Names, ages, and breeds of all other animals living in the house:Your Dog's Information: Dog Name:* Breed: Date of birth (approx): Sex:Male (intact)Male (neutered)Female (intact)Female (spayed) Has your dog ever nipped/bitten a person?*YesNo If yes, describe incident and damage to person: Has your dog ever nipped/bitten another dog?*YesNo If yes, describe incident and damage to dog:Medical History: Veterinarian: Vet Phone: Area Code - Phone Number Vet Address: Street Address City State / Province / Region Postal / Zip Code Does your dog have any health problems we should know about? Does your dog have any food allergies or sensitivities?YesNo If yes, describe allergies/sensitivities: Does your dog have a history of GI issues?YesNo If yes, describe issues:Prior Training: Does your dog have any prior training?YesNo Training done:At HomePuppy ClassBeginning ObedienceBoard/TrainPrivate lessonDog already trained when acquired Describe any other training: Names of previous trainers/training businesses previously used: What does your dog know?SitLie DownOffStayHeelComeShake/PawKennel upLeave itDrop itCatchOther Describe any other commands/tricks that your dog knows: Have you ever used any of the following training methods or tools?ClickerTreat/Food RewardsToy RewardsHarnessHead HalterMuzzleChoke CollarProng CollarRemote/shock training collarRemote/shock barking collarInvisible fenceCitronella collarSonic collar for barkingAlpha rollsSpray water bottlePenny/shaker canGrabbing dog's scruff/jowlsHistory: Where did your dog come from? How long have you had your dog? Is this your first dog?YesNo Why did you choose this dog? What type of food do you feed your dog?KibbleCannedHomemade diet Brand of food: How many times a day is your dog fed? Is your dog free-fed?YesNo What time(s) is your dog fed? Does your dog get "people food"?YesNo What type of treats, cookies, and/or chews does your dog get and how often? Where does your dog sleep? Is your dog allowed on furniture?YesNoSometimesCertain furniture Is your dog house-trained?YesNo Is your dog crate-trained?YesNo Does your dog have accidents (describe)? Percentage of time indoors/outdoors: Hours left alone: Where is your dog kept when no one is home? How often is your dog exercised? How is your dog exercised? What are your dogs favorite toys? What are your dogs favorite activities? What do you like best about your dog? How does your dog typically respond to new people?Tail TuckedLevel, wagging tailHigh, wagging tailLikely to growlCrouchesEars forwardLikely to run forwardLikey to nip/biteEars backLikely to walk forwardLikely to jump upLikely to attackNervous/afraidSomewhat playfulVery playfulProtective of youLikely to ignoreWigglyPushy/in their faceProtective of toysStiffLikely to whineLikely to barkProtective of food Comments (responses to new people): How does your dog typically respond to new dogs?Tail TuckedLevel, wagging tailHigh, wagging tailLikely to growlCrouchesEars forwardLikely to run forwardLikey to nip/biteEars backLikely to walk forwardLikely to jump upLikely to attackNervous/afraidSomewhat playfulVery playfulProtective of youLikely to ignoreWigglyPushy/in their faceProtective of toysStiffLikely to whineLikely to barkProtective of food Comments (responses to new dogs): Describe in detail the specific behavior problems you want to address: What you have tried to solve the problem (please be specific)? What time and resources are you realistically willing to invest in solving this problem? Are you considering re-homing this dog if you are unable to fix the problem behavior?YesNo Are you considering euthanizing this dog if you are unable to fix the problem behavior?YesNo Is there a specific trainer you wish to work with on this case? Preferred appointment times:Weekday morningsWeekday afternoonsWeekday eveningsWeekend morningsWeekend afternoonsWeekend evenings Are you open to virtual consults?Yes!Maybe. I need more information.Only if an in-home trainer is not available.No. Is there anything else you think is important for us to know? reCAPTCHASubmitReset
