Behavioral Questionnaire Name * Name First First Last Last Email * Phone Number * Veterinarian Name * Veterinarian Phone Pet’s Name * Date of Birth/Age * Breed * Weight * Sex * Male Female Spayed/Neutered? * Yes No Age of dog when you got him/her * Age when spayed/neutered * Where did you get your dog? * Breeder (if applicable) Describe previous home(s) if applicable/known For what purpose was your dog obtained? * Behavior of parents or littermates (if known) Briefly describe your dog’s personality (e.g. quiet, excitable, unruly, bold, stubborn, etc.) * Describe the reason(s) you would like training * Type of Food Fed * Amount of Food * When is your dog fed? * Types of Treats Used * When do you give treats? * Appetite * Normal Voracious Decreased Picky Increased Eats Quickly Supplements given * Other than food rewards, what rewards would be most enticing to your dog (e.g. toys, attention)? * Does your dog have arthritis or other painful condition? * Yes No If yes, please describe Have you noticed deficits in your dog’s senses? * Yes No If yes, please describe Does you dog drink water or urinate excessively? * Yes No If yes, please describe Does your dog have any medical issues? * Yes No If yes, please describe List medications Types of exercise/play your dog engages in * Who exercises/plays with your dog? * How often/long does your dog exercise/play? * List your dog’s favorite games * Your dog’s favorite sleeping place * Where does your dog sleep at night? * Have you ever used a crate? * Yes No If yes, describe crate/location Describe your dog’s reaction to being crated * Do you still use a crate? * Yes No If no, when/why did you stop? Briefly describe the usual daily schedule for the family * List other pets (including species, breed, age and sex) * Describe how your pets get along with each other * List each family member living in the home (include sex and ages of children) * Describe how your dog gets along with each family member * Training your dog has had: * Private Instruction Class I trained my dog at home None Describe training classes/instruction your dog has had (include trainer’s name if applicable) * Type of training collar used: None, trained off leash Neck Collar (regular/flat or Martingale) Neck Collar (choke or pinch) Remote Collar (shock, citronella, etc.) Head Halter/Gentle Leader Harness How would you describe past training? * Reward-based Assertive/domineering Aversive/mostly corrections Other If other, please describe Briefly describe training techniques used * Is there any ongoing training? * Yes No If yes, please describe Family members with most control * Family members with least control * Have you used any of the following for punishment or training? * Physical punishment Noise punishment (shaker can/siren) Ultrasonic Water sprayer Verbal reprimand Muzzle grasp Pinning down Time-out Booby traps/repellants Describe your dog’s reaction to punishment used * reCAPTCHA If you are human, leave this field blank. Submit