DOG BEHAVIORAL QUESTIONNAIRE
Please review this entire questionnaire first, then go back and answer the questions as thoroughly as possible. Please return the questionnaire before the appointment if possible. Otherwise please have it with you at time of the appointment. For each specific incident, please, fill out an incident report form.
Today's Date *
Your Name*
Pet’s Name and Age?*
What is your pet's sex? *
Male
Female
Have you had pet's before you got this pet? *
Yes
No
Have you had a dog before?*
Yes
No
Why did you choose this specific animal?*
What is your pet's breed?*
Have you owned this specific breed before?*
Yes
No
Has your pet been spayed and neutered? *
Yes
No
If so, what age was your pet spayed or neutered ?
Where did you get your pet? *
Stray/Found by me or someone In my household
Breeder
Animal Shelter
Pet Rescue
Advertizment (Not Breeder)
Pet Store
Given to Me by a Family Member or Friend
Baby of my other pet(s)
How long have you had your pet? *
How old was he/she when you brought them home?*
When was your last Veternarian visit? *
List their medical conditions/allergies*
Vaccinations in the last 12 months?*
Yes
No
What brand/type of food does your pet eat?*
How many times a day is your pet fed? *
1
2
3
Free Feeding
How many days a week are you away from home?*
0
1-4
5-7
How often is your pet given treats?*
1-4 Daily
1-4 Weekly
5+ Daily
5+ Weekly
How many hours are you away from home?*
0
1-5
6-9
10
How do you prepare to leave home?*
Ignore them
I say goodbye to them
I pet and talk to my pet for awhile
What does your pet do as you prepare to leave?*
Where does your pet spend most of their time ?*
Inside in a crate/cage/room
Outside in a fenced run/cage
Outside in a fenced in yard
Indoors free roaming (unsupervised)
Outside, no enclosure (unsupervised)
Indoors free roaming (supervised)
Outside, no enclosure (supervised)
How often is your dog walked?*
Sometimes
1-2 Times Daily
Never
How often does your dog play in yard?*
Daily
Sometimes
Never
How often do you play with your dog ?*
Daily
Weekly
Where does your pet sleep?*
In or on your bed
In a pet bed/crate in your bedroom
In a crate/pet bed in another room
Anywhere it wants
On the floor or other spot in your bedroom
On the floor or Other spot in another room
What kind of home do you live in?*
Apartment
Townhome
House
Farm/Ranch
List name, species, breed and age of other pets :*
List name, age and sex of people in household: *
What are the issue are you most concerned with? *
Aggression toward people and/or animals
Guarding toys/food/people/pets
Housebreaking
Chewing/eating inappropriate things
Not listening to commands
Biting
Pawing
Separation Anxiety
Stealing/begging for food
Jumping up on people
Mounting people
Nuisance Barking
Pulling on leash/tether
Approximate date/time this behavior started?*
Did a person move in/out of home when it started? *
Yes
No
Was a new baby in home when it started? *
Yes
No
Was a new pet in home when it started?*
Yes
No
Was there a change in owner’s work hours ?*
Yes
No
Was there a change in routine?*
Yes
No
Recent vaccination/new medication?*
Yes
No
Did a pet/person in the home pass away?*
Yes
No
Was another pet lost/rehoused?*
Yes
No
New medical treatment/surgery? *
Yes
No
What has been done to address the issue so far?*
Use of physical corrections
Sent away for training
Training Class
Private In-home Training
Have there been any environmental changes?*
Yes
No
Have you moved recently ?*
Yes
No
Have you changed your pets diet recently ?*
Yes
No
After pet’s behavior was addressed:*
it Improved
it got worse
it stayed the same
Please, list what commands your pet knows.*
Is there anything else you feel we should know?
*
Phone Number *
Address *
Mobile Phone (Fill out forms on mobile)