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Z Behavior History Form Old

To help me prepare for our consult together, please complete the following questionnaire to the best of your knowledge. You will be asked information regarding your dog’s health, history, behaviors, your family routines, expectations/goals for your dog, and why you are currently seeking professional help. I will use this information to help guide me to areas where I will spend time during the consult, digging deeper and gaining additional information.

Day of the consult:

  1. I will be feeding your dog at various points during the session. I need to see your dog’s stress level, and if your dog can or can’t eat is an important investigative tool.
    • Please inform me if your dog has any dietary restrictions prior to our consult.
  2. During the consult, please turn off the television, cell phones, and anything else that may distract you from being focused during the visit.
    • If children are part of the dog’s behavior problem(s), I may want to have them in the room with us at some point.
    • In general, your children are welcome to be involved during the consultation if they are not taking your attention away from your dog or our conversation. This is very important if there is a history of aggression.

HOUSEHOLD INFORMATION

DOG INFORMATION

MEDICAL HISTORY

DIET

EXERCISE

Type can be walks, playtime inside, play with other dogs. Location could be yard, neighborhood, day care, etc. Frequency could be 3 times/day, 2 times per week. Duration could be 30 minutes, one hour, etc.

TRAINING HISTORY

BEHAVIOR PROBLEM/HISTORY

TRAINING GOALS/EXPECTATIONS

In order of priority, what are the 3 most important behaviors you would like to see changes in?

INTERACTIVE BEHAVIOR

Barking, lunging, growling? Tries to move away? Pulling on leash to go say hi.
Barking, lunging, growling? Tries to move away? Pulling on leash to go say hi.

OTHER

Please check the appropriate box for behaviors your dog displays when someone does the following:

Please use descriptive terms such as, “ I want my dog to stop jumping up on people and grabbing them with his mouth, when visitors come into the house.” instead of more general ones like “I want my dog to behave and be good when I have guests to the house.”