Behavior Consult Questionnaire Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number *Address *Address 2City *State *Zip Code *Dog’s Name * allowed do neutered? Dog’s Breed *Dog’s Age (in years) *Where did you get your dog? *BreederShelterPet StoreFriendOtherHow old was your dog when acquired? *Did the dog have previous owners? If yes, please explain *Why did you decide to get a dog? *CompanionFor childProtectionOtherWhy did you choose this breed? *Did you notice anything unusual as a puppy (or when first acquired)? *Have you owned other dogs in the past and if so, which type(s)? *Dog’s Sex *MaleFemaleIs your dog spayed or neutered? *YesNoAge when desexed? *Was your dog desexed due to a behavior problem? *Did you notice a difference in your dog after desexing? *Name of veterinary clinic *Veterinary clinic phone number *Are your dog’s vaccinations up to date? *YesNoDoes your dog have any medical conditions? If so, please explain, including any medications your dog is currently taking. *Please list any other animals in the household. Include names, breed, age, sex and relationship to each other. *If there are multiple dogs, do you need to keep them separate? If so, please explain why and how. *Please describe the social layout of the family (people and pets) and the dog’s place in it. *Has your household changed since acquiring the dog? If so, please explain. *Is your dog an inside dog or an outside dog? If inside, how often are they allowed out and are they unsupervised? If an outside dog, are they ever allowed inside? *What type of exercise does your dog receive and how often? *When is your dog fed? *MorningEveningBothOtherWhat do you feed your dog? *Canned foodDry foodTable scrapsRaw dietOtherWhat brand(s) do you feed your dog? *What best describes your dog’s eating habits? *PickyHardyOtherIf your dog does not eat all of their food at once, how long is the food left down? *Is your dog crate trained? *YesNoWhere does your dog sleep? *On the bedIn a crate or kennel insideIn a crate or kennel outsideOn own bed insideOn own bed outsideOtherDescribe your dog’s reaction to being left alone. *Where do you leave your dog when you go out? *Outside with run if the yardOutside confined in a crate or kennelInside, with run of the houseInside, confined in crate or kennelDescribe your dog’s reaction when you return home. *Does your dog have any toilet training problems? *Is your dog comfortable around children? If not, explain *Please explain how your dog gets along with other animals in the houshold. *How does your dog react to unknown dogs? *How does your dog react to guests and strangers? *Has your dog ever been to obedience school or private lessons? If so, where did your dog attend and for how long? *Will your dog lay down on cue? *YesNoDoes your dog pull on the lead when being walked? *YesNoWhat equipment do you use to walk your dog? ie flat collar, choke chain, prong collar, shock collar, harness, flexi lead *What is your dog’s most undesireable behavior? *Please list other undesireable behaviors in the order of highest priority to lowest. *Has there been any change in frequency or severity of the problem behavior(s)? Please describe. *What have you tried so far to modify these behaviors? *Why do you think your dog is displaying these behavior problems? *Beginning with the most recent, describe any and all instances of aggression, including lunging, growling, biting, snapping, barking, baring teeth and injuries to people or other animals. Describe the circumstances during which they occurred. *Any other comments or information you think I should know?Submit
