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? *

Has this dog had other owners? *

If yes, how many? *

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

First

Last

Is your dog left alone during the day? *

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 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:

Name *

Name

Hours away from home *

Hours away from home

Age *

Age

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

Pet's Name *

Species *

Breed *

Sex *

Male
Female

Spayed/Neutered *

Male
Female

Age *

Do you have an additional pet? *

Yes
No

Do you have an additional pet? *

Yes
No

Do you have an additional pet? *

Yes
No

Do you have an additional pet? *

Yes
No

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:

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

Please Note: We will be closed on Wednesday, January 1st in observance of New years!

Background Information

Behavior Problem Information

We provide exceptional pet care in Union, KY!

Address

Contact Us

Hours