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Adolescent and Adult Dogs
Aggressive Behavior
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Behavior History Goal Assessment 2022
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General Information
Client's Name
*
Date
*
Client's Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
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Nevada
New Hampshire
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New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Email
*
Pet Information
Dog's Name/ID:
*
Breed/Age/Sex/Age Neutered:
*
Age of Dog When Adopted:
*
Briefly describe your dog’s personality (ex: quiet, excitable, shy, confident, etc.):
*
Pet Information - Medical
What medications is your dog taking?
*
Has your dog had any recent surgeries or illnesses?
*
Has your dog had any recent ear infections?
*
Has your dog had any recent skin allergies?
*
What is the approximate date your dog's next rabies vaccine is due?
*
Household Information
Describe any additional household pets:
*
Describe family members living in the house (include children's ages if under 18)
*
Training History/Reinforcers
Have you taken your dog to group classes?
*
Select
Yes
No
Have you taken your dog to private training?
*
Select
Yes
No
Have you tried to train your dog yourself?
*
Select
Yes
No
How do you stop your dog from doing an unwanted behavior? How do they react?
*
Daily Routine
Describe the type and frequency of daily physical exercise the dog gets?
*
How many times a day does your dog eat?
*
What types of food does your dog eat?
*
Dry
Wet
Raw
Table Scraps
Behavior of Concern
What behaviors are you seeking help with?
*
Describe the problem behavior(s):
*
How often does the problem behavior occur?
*
When did you first begin to notice this behavior?
*
Has your dog ever injured a person or animal?
*
Have you spoken with your veterinarian regarding this problem behavior?
*
Submit