Dog Behavior History Form - Please answer with as much detail as possible.
* All questions must be answered or the form will be discarded *Enter "n/a" if you do not have an answer or if the question is not applicable to your situation.
Client Information
Name:
Email:
Phone:
Address:
Describe your home:
Own / Rent:
Pet Information
Pet's Name:
Nickname:
Breed:
D.O.B.
Age & sex:
Please indicate spay/neuter
Age altered:
Age obtained:
Color(s):
Obtained from where?
Cost:
Initally shy or outgoing?
Housebroken?
Method of Housebreaking:
Obedienced trained?
Where?
Describe training method used:
What type of collar was used?
Skills the dog is proficient with:
Where does the dog sleep?
Crate trained?
Allow on the furniture?
Fave treat:
What brand of food is fed?
Daily amount:
Who feeds the dog?
Fed table scraps?
Health Information
Clinic/Veterinarian's name:
Vet phone:
Last veterinary appointment:
Reason:
Please describe health history:
List current medications:
Health/medication comments:
List all household members:
Ages of each member:
List type and age of other pets:
Do other current pets have behavior issues? Please explain.
Describe the dog's exercise area:
Describe the dog's daily exercise routine:
How long is the dog exercised each day?
Fave type of play?
Describe the dog's reaction to being left alone:
Describe the dog's behavior upon your returning home:
Is the dog crated?
How long/day?
List the toys the dog has:
Behavior Issue Details
Age the issue was first noticed:
Location:
Describe the event in detail:
What happened immediately after?
What seemed to trigger the behavior?
What was your response?
Describe any punishments:
How often does this behavior occur?
Recent increase?
Any family/home changes recently?
What have you tried so far?
Please describe in detail, the most recent event
Have you consulted other trainers?
Whom?
If yes, what did they suggest?
Have you considered giving up the dog?
Why haven't you?
What is your goal with this training?
Training budget:
Scheduling Details
What days & times are best?
Alternate:
Detailed driving directions:
How did you hear about us?
Add any additional information here:
A $25.00 deposit is required prior to our beginning a behavior modification plan for your dog. The $25.00 is fully refunded by means of a credit towards your first session invoice. You will have the option of making this deposit on the page that follows the submission of this form.
Please allow 24-36 hours for a reply. In the meantime, please ask your veterinarian to fax your dog's vaccination paperwork to us at: 603-536-4216