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Canine Behavior Questionnaire

Name

Age Required/ Where

Other pets in the home

List any life events or recent lifestyle changes that may be relevant to problematic behaviors

List each behavior problem or complaint separately.

For each behavior problem listed: (1) What is the trigger (2) When does it occur and (3) How long has it been going on for

List any medications and/or supplements you have tried and what was the response to these medications?

List any behavioral interventions (management or training) you have attempted and response:

What equipment do you use with your dog (collar, leash, crate, muzzle, treat bag, etc.)

If applicable, please list any trainer you have worker with in the past or currently:

Does your dog exhibit fearful response to sudden loud noise

Yes

Dose your dog exhibit aggressive behavior over resources

Yes

Has your dog ever bitten a person or other animal

Yes