Behavioural Questionnaire

Behavioural Questionnaire

Please also complete an Intake Form
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Dog's Name
Dog's Age
Type a question
Date of last Vet Visit?
Did you discuss the behavioural issue with the vet? (either at this visit or previously)

Yes No
What was the vet's recommendation regarding the behaviour?
Is your dog on any medication or supplements?

Yes No
What medications or supplements does your dog take?
What unwanted behaviour(s) is your dog displaying?

Excessive barking Aggression towards humans (growling, snapping, biting or barking) Aggression towards dogs Resource guarding from humans (food or possession aggression) Resource guarding from dogs (or other pets) (food or possession aggression) Sound phobia / storm, firework fears Lunging at traffic (including joggers or bicycles)
When did these behaviours start?
How often does this happen?
Where does the behaviour occur?
If more than one issue, list where each behaviour occurs
Were there any changes to the household when they started
Eg., new pet, pregnancy or new baby, house move, loss of other pet, adult children moving out, new neighbours, etc.
Describe what the behaviour looks like in detail
Describe the most recent incident
How much does the behaviour occur since it started
Has the intensity of the behaviour (how bad it is) changed since it started
Who is present when the behaviours occur
List all
What has been done so far to address this problem?
(eg., change in schedule, equipment, training - include methods)
How much time and effort are you willing to put in to resolve the issues?
Daily/weekly/monthly? How much time each day can you dedicate?
Can you offer any information that you think might be helpful or relevant?
What behaviours would you like your dog to perform instead of the unwanted behaviours?
Is there anything else you would like your dog to learn?
Anything covered by Intake Form does not need to be re-stated here
Example for question below: At 100 feet dog notices man with beard and becomes tense. At 80 feet, dog's hackles rise and she stands on her tip-toes, at 70 feet she beings leaning forward, at 60 feet she beings growling and pacing, at 50 feet she begins to lunge and bark. Please be as specific as possible without 'testing' your dog additionally. However, make a list of approximate distances and reactions for each of the dog's triggers.
If this is a fear/aggression issue, how far away is the trigger (thing dog aggresses towards: dog, person, car, cat, whatever) before you notice the dog's reaction? What does the reaction usually look like? (Please specify feet/meters)
Refer to Body Language and Ladder of Aggression handouts to describe behaviours
Anything else you think we should know?
Should be Empty:

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