How old was your dog when you brought him/her home?
Please be as accurate as possible. Use veterinary/breeder/shelter records if necessary to supply accurate dates.
Are there other pets in the home?
Please provide species (dog, cat, etc) and age. Please include small animals, like rabbits, gerbils, birds, etc.
Select the behaviors that you have observed from your dog Barks for no reason bolts through doors won't come when called won't respond to his/her name Mouths and chews my hands Grabs shoelaces and pant legs when we walk Grabs the leash and likes to play tug of war on walks Won't "tell" me he/she has to "go" to the bathroom Will urinate when excited or afraid Will run to another room and potty on the floor Will potty in crate without "saying" he/she has to "go" Poops and pees on bedding in crate Poops and pees on carpet in the home Poops and pees anywhere in the home Will chew bedding in crate Likes to chew couch cushions, shoes or other household items Destroys toys as soon as I offer them Cries and barks in crate all the time Wakes up in the middle of the night to "go" outside Has broken out of the crate when owners are absent Has injured him/herself trying to escape from a crate Has never been crated Dog is contained with an electric fence in the yard while owners are absent Dog is contained by a traditional fence in the yard while owners are absent Dog stays in a kennel run when owners are absent Dog jumps/digs under or climbs/breaks through the fence when left out too long Dog destroys the back yard when left alone Neighbors have complained about barking while owners are absent Dog has access to a dog door when owners leave the house Climbs on chairs, coffee tables and counters Dog barks/jumps and/or paws at owners Dog barks/jumps and/or paws at guests Dog barks/jumps and/or paws at strangers while on walks Dog barks/jumps and/or paws at strange dogs while out on walks Dog "humps" bedding/pillows, other inanimate objects Dog "humps" owners or members of the immediate family Dog "humps" guests to the home Dog "humps" other dogs regardless of age, sex or social status Steals food off of tables and counters Has stolen food out of people's hands Has acted aggressively in the presence of human food Has acted aggressively in the presence of dog food Will act aggressively with toys or other objects Has become aggressive when approached while sleeping Has become aggressive while being pet or stroked Has become aggressive while sitting on or near a family member and is approached by another family member Will bark and lunge at strangers on walks Will bark and lunge at guests in the home Will bark and lunge at the veterinarian or other caregiver Will bark and lunge at strange dogs while on leash Has snapped and tried to bite strangers on walks Has snapped and tried to bite guests in the home Has snapped and tried to bite the veterinarian or other caregiver Has snapped and tried to bite strange dogs while on walks Is fearful of strangers on walks Is fearful of guests in the home Is fearful at the veterinarian or with other caregiver Is fearful when meeting other dogs on leash Is fearful and anxious in general Is anxious when left alone Gets sick when traveling in cars Has never been to a dog park Bullied other dogs at the dog park Was bullied at a dog park Has been in a fight at a dog park Has never been to a dog daycare Attempted a daycare but failed the temperament evaluation Has been removed from a daycare for behavior issues Has shown aggression toward other dogs and small animals Has attacked and injured another dog or small animal Has attacked and injured multiple animals, including other dogs Has killed another dog or other animal Has bitten a human Has bitten more than one human Has been on an Animal Control Bite Hold Citation Dog fights or attempts to escape when I, my vet or other caregiver brush him/her Dog fights or attempts to escape when I, my vet or other caregiver try to bathe him/her Dog fights or attempts to escape when I, my vet or other caregiver try to cut his/her nails
Select as many as apply. For multiple answers, you will need to press CONTROL on your desktop as you select each behavior. There are no wrong answers! The more behaviors you identify, the more precise our evaluation will be!
Have you attempted anything to remedy these behaviors?
If you have attempted training on your own, please describe your efforts to the best of your recollection
Please provide an itinerary of your dogs average day
Please be accurate. Start with what time you and other household members rise, and depart from the home; when your dog is fed, exercised, etc. Include naps if any, walks if any, duration of either, where the dog spends his/her day and with whom, doing what. This is important to determine if certain behaviors are triggered by certain events
How is your dog exercised each day? "Block" stroll, two times a day to potty, rain or shine "Block" stroll one time a day in the evening on pleasant days AM and PM walks before and after work of at east a mile total AM and PM walks before and after work of at east a mile EACH We go hiking once a week We go hiking more than once a week, but less than 4 times We go hiking more than 4 times a week We take our dog to a dog park every night We take our dog to a dog park three nights a week We take our dog to a dog park occasionally Our dog is enrolled in Daycare 5 days a week Our dog is enrolled in Daycare 4 days a week Our dog is enrolled in Daycare 3 days a week Our dog is enrolled in Daycare 2 days a week Our dog is enrolled in Daycare 1 day a week We take our dog to the local walking trail up to 3 nights a week We take our dog to the local walking trail less than 3 nights a week Our dog has a big back yard, he plays by himself Our dog has a big back yard, we play fetch or other games with him every night Our dog rarely gets exercise because we are so busy Our dog is small and gets enough exercise in the house
Please be accurate and honest! If your dog is not exercised every day, select the appropriate option. It is important information that can help pinpoint behavior issues more accurately, and help us devise easy things to do that will enrich your dogs' life and make you feel less guilty! Select as many as appropriate!
Do you have a lot of visitors to your home?
Please describe; extended family, friends of adult family members, friends of minor children and frequency of visits; once a week, a few times a week, daily. etc.
If your dog has ever bitten, human or animal, please explain:
Biting includes mouthing and grabbing, even in play. If you believe your dogs mouthing behavior is play oriented, please indicate that in your explanation.
Has your dog been diagnosed with any health issues?
Please share any health issues your dog may be suffering from, including allergies, to what, current treatment, including any medications: thyroid condition, Lymes, surgical interventions for hip/elbow dysplasia, luxated patellas, etc. Any illnesses your dog may have been treated for as a puppy can be included here as well, like parvo, distemper, shipping cough, etc.
How long ago was your dogs last veterinary visit and for what reason?
Please list booster shots, if any, parasite treatment, if any, Well Senior visit, Well Puppy visit, etc. and the date in MM/DD/YYYY format
Is there anything else you feel we should know about your dog?
If there is anything we may have missed in our questionnaire, please feel free to provide it here! Thank you for your patience!
