Behavior History Goal Assessment 2022

Client's Name *

Date *

Client's Address

Address Line 1

Address Line 2

City

State

Zip Code

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? *

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? *

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? *

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? *