Canine Training Team Behavioral Questionnaire Today's Date * MM DD YYYY Owner's Name * First Name Last Name Dog's Name * Phone * Email * What is the main issue you are concerned about? (Check all that apply.) Aggression toward unfamiliar dogs Aggression toward another dog or pet in the home Aggression toward family member(s) Guarding food/toys/possessions/other Aggression toward visitors Aggression toward unfamiliar people in public Aggression when handled/picked up Aggression toward vet/groomer/petsitter/dogwalker Other When did this behavior start? (approximate date or how long ago) * Please check off any of the following that coincided with the change in your dog’s behavior: Person moving out of home New person/baby in home New pet in home Pet in home dying/lost/rehomed Change in owner’s work hours Change in amount of exercise Recent vaccination Put on new medication Medical treatment/surgery Environmental change Moved to new location Change in diet/new treats (e.g., construction in home) Use of physical corrections Sent dog away for training Less time to spend with dog Other/Further Description What has been done to address the issue so far and did your dog’s behavior improve, worsen, or stay the same? * If your dog has threatened or bitten another dog, please check all that apply. Growls, lunges, and/or barks at other dogs on walks Has air-snapped at another dog (no contact) Growls, lunges, and/or barks at another dog in home Bit another dog while your dog was on leash Bit another dog while your dog was off leash Play between dogs at home escalates into fights Bit another dog, drew blood (for example, torn ear) Bit another dog, inflicted puncture wound Bit another dog, inflicted multiple puncture wounds Tried to kill other dog (e.g., “grab and shake”) Other: If your dog has threatened or bitten a person, please check all that apply. Threatened (for example, growled, barked, air-snapped, lunged at) family member, but no bite Threatened (for example, growled, barked, air-snapped, lunged at) stranger in public, but no bite Threatened (for example, growled, barked, air-snapped, lunged at) visitor to home, but no bite Bit family member, no broken skin Bit family member, broke skin (tear) Bit family member, single puncture wound Bit family member, multiple puncture wounds Bit stranger in public, no broken skin Bit stranger in public, broke skin (tear) Bit stranger in public, single puncture Bit stranger in public, multiple puncture wounds Bit visitor, no broken skin Bit visitor, broke skin (tear) Bit visitor, single puncture Bit visitor, multiple puncture wounds Bit vet or vet tech Bit groomer Bit dogwalker/petsitter Other/Further Description: * If there was a bite: What was the location on the body? * Did it cause bruising? * Yes No Were there multiple puncture wounds? * Yes No Was there a puncture wound? * Yes No Did the dog bite, latch on and shake his head from side to side, not letting go? * Yes No Who was present? * What other dogs/animals were present? * Was your dog on leash? Yes No What preceded the incident? * Had your dog been feeling well prior to the incident? * Did your dog give any warning signals? If so, what were they? * How did the incident end (for example, pulled dogs apart, one dog walked away, person ran away)? * What happened right after the incident (for example, put dog in yard, hit dog, dog lay down, dog looked “guilty”)? * If there was a bite was: * Medical help sought? It reported? Legal action taken? Which of the following best describes your feelings about your dog’s behavior issue? * The problem is not serious, but I am curious about what you would suggest. I would like to change the problem, but it is not that serious. The problem is somewhat serious. I would like to change it, but if it remains unchanged we will live with it. The problem is very serious. I would like to change it, but if it remains unchanged I will keep my dog. The problem is extremely serious. I would like to change it. If it remains unchanged, I will give my dog up or have him/her euthanized. Thank you!
