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The Inquisitive Canine

Behavioral Questionnaire

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Behavioral Questionnaire

CLIENT INFORMATION

Your Name*

Referred By

Street Address

City

State

ZIP

Phone*

Your Email*


DOG INFORMATION

Dog Name*

Breed*

Gender*

Current Age*

Age Obtained*

Acquired From

If rescued, where from?

If other, please describe...

Veterinarian Name

Veterinarian Phone

City where veterinarian is located:

Spayed/Neutered?

If planning, date when scheduled...

If completed, how old was your dog?

Any changes following procedure?

Specific Medical Conditions

If yes, please list...

Current medication name(s) and corresponding condition...


RESIDENTIAL HISTORY & HOME ENVIRONMENT

Describe your neighborhood

Have you moved since acquiring your dog?

Have there been any changes in the household since acquiring your dog?
DeathBirthMarriageDivorceOthers moving in/outChanges in schedule

Describe your home

Do you have a yard?

Do you have a patio or deck?

List all the people living in the home, including children (please include child ages - you may select more than one age range)


Describe how your dog gets along with each family member

List all other pets living in the home (please include species, breed, gender & age)

Describe how your dog gets along with other animals living in the home (play together, fight, sleep together, etc...)

Where does your dog sleep at night?

Where does your dog stay when left alone? (when humans aren't home)

Has your dog been crate-trained?


TRAINING HISTORY

Please list and describe any previous training and methods used (classes, private training, other...)

Does your dog offer or know of any of the following?
SitStayDownWalk on loose leashHeelCome when calledWait at doorsNot to touch things when asked to

Which motivators does your dog respond to?
FoodToys/GamesPraise/PettingNo rewards given

List any situations in which your dog is less likely to listen to your commands

Is there one specific person that will continue the training plan, or will all members of the family be involved?


A DAY IN THE LIFE OF YOUR DOG

Describe a typical 24-hour period for your dog (including exercise, activities, play, left alone...)

List equipment you use for walking your dog:

Please list food(s) you give your dog, amount and at which time(s) of the day:

How are meals delivered?
BowlPuzzle toysHand fedOther

If other, please describe:

List your dog's favorite food, treats, toys, games and activities


DOG BEHAVIOR - Paint a Picture

Describe how your dog reacts to the following:

When your dog is OFF LEASH and sees a FAMILIAR dog (choose all the apply)
wiggles body & wags tailjumps up and downgreets other dogbarkslungesignores (walks away)hides/cowersrolls onto backgrowlssnarlssnaps

When your dog is OFF LEASH and sees an UNFAMILIAR dog (choose all the apply)
wiggles body & wags tailjumps up and downgreets other dogbarkslungesignores (walks away)hides/cowersrolls onto backgrowlssnarlssnaps

When your dog is ON LEASH and sees a FAMILIAR dog (choose all the apply)
wiggles body & wags tailjumps up and downgreets other dogbarkslungesignores (walks away)hides/cowersrolls onto backgrowlssnarlssnaps

When your dog is ON LEASH and sees an UNFAMILIAR dog (choose all the apply)
wiggles body & wags tailjumps up and downgreets other dogbarkslungesignores (walks away)hides/cowersrolls onto backgrowlssnarlssnaps

Describe how your dog reacts to the following (Please use the following word(s) to help describe your dogs behavior. Choose all that apply. If you are uncertain, you may leave blank and we will discuss it further during the consultation)

Familiar people at your home
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Familiar people away from home
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Strangers that come to your home
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Strangers away from your home
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

When YOU are near your dog's food/toys
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

When you (or other people) take away food/toys from your dog
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

When other dogs are near your dogs food/toys
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Near joggers/cyclists/skateboards
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Near cars/trucks
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Near cats/squirrels
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Near children running and playing
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Near people in uniform
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

During visits with the veterinarian
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Loud noises
wiggles body & wags tailjumps up and downwhinesbarkslungesgrowlssnarlssnapshas bittenhides/cowersignores (walks away)no problem

Please indicate your dogs response to the following:

Petting
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Handling face/muzzle
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Handling paws
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Grooming
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Nail trimming
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Bathing or toweling off
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Physically waking up from resting spot
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Physically or verbally removing from furniture
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Pick dog up
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Restrain dog
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Putting on or removing collar/harness/leash
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Reaching for or grabbing collar
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Staring at your dog
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Using force to get your dog to respond to a command
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Reprimanding in loud voice
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Visually threatening with hand or object
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Hit dog
freezesgrowlssnarlssnapsbitesno aggressive responsehaven't tried

Has your dog ever growled at, snapped at, or bitten another animal or person?

If yes, please describe in detail, including any medical treatment required


REASON(S) FOR CONSULTATION

Check all that apply:
No specific problems - just need basic good mannersAdvancing SkillsJumping UpDoor DashingBehavior issue(s)house-trainingchewing/mouthing inappropriatelybarking (incessant)diggingpulls on leashon leash barking towards other dogson leash barking towards peopleshy or appears withdrawn when around unfamiliar people or placesappears 'scared' before being left alone (pacing, whining, panting, not taking food, clinging to owner/family)other

If you selected "Other" - please describe...

For specific behavior issue, please describe and go to next section of questions.

Age of onset

When did the problem start?

How often does the problem behavior occur?

Has the situation become worse, better, or changed?

How long does each incident last?

Since onset, have there been any changes in the pattern of behavior problem, including: how often it occurs, intensity, or time episode lasts?

Have you or anyone else noticed any specific triggers that cause your dog to behave in this manner?

Can your dog be interrupted when engaged in behavior?

Describe any methods used so far to stop the behavior

Describe any changes in behavior since providing help?

Please provide detailed description/date of last time this problem occurred


CLIENTS GOALS and WISH LIST

Please provide three answers to each of the following three questions. If unsure, just list the first thing that comes to mind. You may re-evaluate and make changes at any time.

I love when my dog:

I wish my dog wouldn't:

I wish my dog did:


On behalf of The Inquisitive Canine, I thank you for your time, and for being such a responsible and loving dog guardian!

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