859-384-7702 info@unionpethospital.com

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Canine Behavior Questionnaire

Client Name *

First

Last

Email *

Dog's Name *

Date *

Background Information

How long have you had your dog? *

How old was your dog when you first acquired him/her? *

Where did you get your dog? *

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Has this dog had other owners? *

If yes, how many? *

How much time does your dog spend indoors/outdoors? *

First

Last

Layout (copy)

Is your dog left alone during the day? *

How long? *

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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? *

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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 below: *

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:

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Name *

Name

Name

Name

Name

Hours away from home *

Hours away from home

Hours away from home

Hours away from home

Hours away from home

Age *

Age

Age

Age

Age

Please list all animals, including the one you are bringing in to see us, in your household:

Pet 1

Pet's Name *

Species *

Breed *

Pet 1

Sex *

Male
Female

Spayed/Neutered *

Male
Female

Age *

Do you have an additional pet? *

Yes
No

Pet 2

Pet's Name *

Species *

Breed *

Pet 2

Sex *

Male
Female

Spayed/Neutered *

Male
Female

Age *

Do you have an additional pet? *

Yes
No

Pet 3

Pet's Name *

Species *

Breed *

Pet 3

Sex *

Male
Female

Spayed/Neutered *

Male
Female

Age *

Do you have an additional pet? *

Yes
No

Pet 4

Pet's Name *

Species *

Breed *

Pet 4

Sex *

Male
Female

Spayed/Neutered *

Male
Female

Age *

Do you have an additional pet? *

Yes
No

Pet 5

Pet's Name *

Species *

Breed *

Pet 5

Sex *

Male
Female

Spayed/Neutered *

Male
Female

Age *

Behavior Problem Information

Please describe your dog’s behavior problem: *

How often does this problem occur?

When 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:

house soils
destructive chewing
aggressive
destructive scratching
shy
jumps on people
excessive grooming
bites when verbally scolded
barking or lunging on a leash
pacing
fighting with other dogs
tail chasing

Please discuss any other information you feel is relevant to your dog’s problem: *

We provide exceptional pet care in Union, KY!

If you need anything at all, please contact us! Our team is here to help. If you’re having an after-hours emergency, we recommend the MedVet Cincinnati – 513-561-0069.

Union-Pet-Hospital

Contact Us

Call: 859-384-7702
Fax: 859-384-7905
Email: info@unionpethospital.com

9842 Old Union Rd.
Union, KY 41091
Click here for directions.

Mon – Fri: 8:30 am – 5:30 pm
Sat: 8:30 am – 1:00 pm
Sun: Closed

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New Clients
- What To Expect
- Payment Options
About Us
Services
Resources
- Medicating Cats
- Diabetic Resources
Online Store
Forms
Contact
- Contact Us
- Appointment

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