Behavior History & Goal Assessment

General Information

Client's Name:

Date:

Client's Address:

Home/Cell Phone:

Email:

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.):

What medications is your dog taking?

Has your dog had any recent surgeries or illnesses?

Describe any additional household pets:

Describe family members living in the house (include children's ages if under 18)

Have you taken your dog to group classes?

Have you taken your dog to private training?

Have you tried to train your dog yourself?

How do you stop your dog from doing an unwanted behavior? How do they react?

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?

Describe the problem behavior(s):

How often does the problem behavior occur?

How long has the behavior been occurring?

Has your dog ever injured a person or animal?

Have you spoken with your veterinarian regarding this problem behavior?

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