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Dog Behavior Questionnaire
Please enable JavaScript in your browser to complete this form.
Owner's Name
*
First
Last
Email
*
Appointment Date and Time (if already scheduled)
Date
Time
Pet's Age
Pet's Breed
Pet's Sex
How long have you had your dog?
How old was your dog when you first acquired him/her?
Where did you get your dog?
Has this dog had other owners?
Yes
No
If yes, how many?
How much time does your dog spend indoors? (%)
How much time does your dog spend outdoors? (%)
Is your dog left alone during the day?
Yes
No
If yes, for how long?
Is your dog crate-trained?
Yes
No
How much time does he/she spend in the crate?
Where is the dog kept when your family is home? (ie: crate, yard, garage, etc)
Where is the dog kept when your family is away?
Where is the dog kept when your family is asleep?
What amount of exercise or opportunity to exercise is given to the dog?
Is your dog leash-trained?
Yes
No
What type of leash do you use?(ie: choke, flat, head halter, pinch/prong)
Has your dog had any formal obedience training?
Yes
No
What will your dog do on command? (ie: sit, stay, come)
Does your dog get along well with other animals?
Yes
No
If no, please explain:
How does this dog react to unfamiliar people?
How does this dog react to children?
Please list all people, including yourself, living in your household:
Name
Hours away from home
Age
Name
Hours away from home
Age
Name
Hours away from home
Age
Name
Hours away from home
Age
Name
Hours away from home
Age
Please list all animals, including the one you are bringing in to see us, in your household:
Name
Species/Breed
Sex/Neutered?
Age
Name
Species/Breed
Sex/Neutered?
Age
Name
Species/Breed
Sex/Neutered?
Age
Name
Species/Breed
Sex/Neutered?
Age
Name
Species/Breed
Sex/Neutered?
Age
Behavior Problem Information:
Please describe your dog’s behavior problem:
How often does this problem occur?
Please select all that apply
Does it occur when the dog is left alone?
When the family is sleeping?
In the presence of a family member?
What has been done so far to correct this problem? (discipline, confinement, obedience training, etc)
What was your dog’s response to the correction?
Please describe all situations which are likely to elicit aggressive behavior such as growling, nipping, biting, attacking, etc. (ie: petting, approached by adults, approached by children, only when in the car, reaching for, punishing, taking food or toys away, disturbed while sleeping, etc)
Please indicate any other behavior problems: (Select all that apply)
House soils
Shy
Pulls hard on leash
Destructive chewing
Jumps on people
Pacing
Aggressive
Excessive grooming
Barking
Fighting
Digging
Runs away
Destructive scratching
Bites when verbally scolded
Swallows non-food items
Tail chasing
Please discuss any other information you feel is relevant to your dog's problem:
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