Behavioral Questionnaire

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Behavioral Questionnaire

PLEASE FILL-UP ALL THE QUESTIONNAIRE STEP BY STEP.

How did you hear about us?
  • - select a option -
  • Word of Mouth/Referral
  • Internet Search/Google
  • Facebook
  • Local Pet Store
  • Postcard
  • Digital Billboard
- select a option -
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Your First Name
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Your Last Name
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Your Address
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City
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State
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Your Phone number
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Zip Code
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Your Email Address
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Do you or anyone who will handle your dog have any physical limitations that would either prevent or make it difficult for you or them to train your dog? Please list or explain:
List or Explain here. (If Not Please Type "None")
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EMERGENCY CONTACT (IF OWNER CANNOT BE REACHED)

Phone number
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EMERGENCY CONTACT NAME
Name
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Veterinarian
Veterinarian Name
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Phone number
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Does your dog have any medical conditions? If so, please explain, including any medications that your dog is on.
List here.
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Dog Information

Dog's Name
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Breed?
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Age?
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Weight
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Sex?
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How long have you owned your dog?
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What are your training goals?
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Spayed or Neutered?
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Is your dog up to date on vaccinations?
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Markings
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Birthday
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Micro Chip Number
If no Chip Number Please input "NA"
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Rabies Tag Number
If no Rabies Tag Please input "NA"
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Age when spayed/neutered?: Was your dog spayed/neutered due to a behavior problem? Did you notice a difference in your dog after the procedure? Please explain.
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What type of exercise does your dog receive and how often?
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When is your dog fed?
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What is your dog fed?
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If you feed dog food what brand is it?
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Which best describes your dog's eating habit?
  • - select a option -
  • Fussy
  • Normal Appetite
  • Gluttonous
- select a option -
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Is your dog allowed inside? If no, why is this? If yes, how often?
Type your answers here.
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Family, Other People & Animals

Please describe the social layout of the family (people and pets) and the dog’s place in it.
Describe here.
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Has your household changed since acquiring the dog? If so, please explain.
Please explain.
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Does your dog like children? If not, please explain.
Please explain.
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How does your dog react to guests & strangers?
Please explain.
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Please explain how your dog gets along with other animals in the household.
Please explain.
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How does your dog react to unknown dogs?
Answer here.
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Previous Training

Has your dog ever been to obedience school or private lessons?
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If so, where did your dog attend and for how long?
Answer here.
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Will your dog lie down on command?
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Does your dog pull on the lead when being walked?
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What equipment do you use to walk your dog?
  • - select a option -
  • Flat Collar
  • Choke Chain
  • Harness
  • Halti
  • Other
- select a option -
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Reason for Consult

What is your dog’s most undesirable behavior? Please list all other undesired behaviors in order of highest priority to lowest.
Please list here.
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Why do you think the dog is displaying these behavior problems?
Give me your thoughts here.
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Has there been a change in frequency or severity of the problem? Please describe.
Describe here.
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What have you tried so far to fix the problem?
List here.
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Aggression

Describe any and all instances of aggression including, lunging, growling, biting or baring teeth:
List here.
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Dog Selection

How old was your dog when you acquired it? Had the dog had previous owners? If yes, please explain
Explain here.
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Where did you get your dog?
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Why did you decide to get a dog?
  • - select a option -
  • Companion
  • For Child
  • Protection
  • Therapy
- select a option -
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Why did you choose this breed?
Please explain here.
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Did you notice anything unusual as a puppy?
Please describe.
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Have you owned other dogs in the past and if so which types?
Answer here.
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General Information

Where does your dog sleep?
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Does your dog have any toilet training (Potty Trained) problems?
Please explain.
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While You Are Out

Describe your dog’s reaction to being left alone.
Describe here.
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Where do you leave your dog when you go out?
Type here.
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Describe your dog’s reaction when you return home.
Describe here.
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Do you use a crate?
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Final Comments

Any additional comments or information you think I should know?
Type here.
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To the best of your knowledge have you ever had any dog with the Parvo virus on your property?
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Submit