Questionnaire for behavior

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Email behavior assessment

 

Medical:

How old is your dog:

Does your dog have any medical issues:

When was the last time you took your dog to the vet:

What does your dog eat:

How do you feed your dog:

Any thing else worth noting:

 

History:

Breed:

Where did you get the dog be specific which rescue or breeder:

Do you know if littermates or parents had similar issues:

Did you contact the place you got your dog from and what did they say:

How long ago did you get your dog:

What do you know about your dog’s history (type of socialization, foster, breeder ect):

 

Additional Questions:

What is your dog’s daily routine look like?

What causes your dog to react make a list of everything you can think of?

Has your dog ever bitten a person or dog before?

Does your dog growl if you take him off of furniture?

What cues does your dog know?

Is your dog kennel trained?

 

 

Goals:

What do you want to work on with your dog:

List at least three goals:

1.

2.

3.

4.

5.

 

If your dog has any of the following issues please fill out additional questions: ANXIETY, DOG-DOG ISSUES, DOG-HUMAN ISSUES

 

Anxiety:

When did you first notice the problem:

Does your dog poop/pee when alone:

Does your dog cause self harm when alone:

Does your dog seem unable to relax:

Does your dog cause destruction?  If so where in the house be specific

Does your dog whine and pace?

 

Dog-dog aggression or reactivity:

When did you first notice the problem?

What does your dog do when he sees a dog on-leash?

What does your dog do when he meets a dog off-leash?

Has your dog ever bitten another dog?

If so….. How bad was each incident? (How many puncture wounds, did the dog have to be pulled off, was professional care required to treat)

How many times has your dog bitten another dog?

Any additional known dog- dog history known?

 

Dog-Human:

When did you first notice the problem?

What does your dog do when he sees a person when he is on-leash?

What does your dog do when he meets a person and is off-leash?

Has your dog ever bitten a person?

If so….. How bad was each incident? (How many puncture wounds, did the dog have to be pulled off, was professional care required to treat)

How many times has your dog bitten a person (clothing, or skin)?

How many of those broke skin?

Is your dog muzzle trained?

 

 

 

 

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