Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any additional behaviour concerns?

Destructive behaviour

Digging

Excessive barking

Hyperarousal

Humping/Mounting

Jumping

Pulling on lead

Separation Related Behaviours

Aggression towards other dogs

Aggression towards people

Guarding of toys

Guarding of food

Has the dog had any procedures or surgeries, past or present? (including desexing) *

Yes

No

On average, how often do you exercise the dog per day? *

Twice per day or more

Once per day

A couple of times a week

Once a week

Rarely

Never

On average, how long are these exercise sessions? *

More than 1 hour

45 - 60 minutes

30 - 45 minutes

15 - 30 minutes

Less than 15 minutes

Not applicable

On average, what is the intensity of each exercise session? *

Run

Jog

Brisk walk

Slow walk

Enrichment walk (dog is allowed to sniff and go at own pace)

t applicable

How do you walk the dog? *

Flat collar

Front attaching harness

Back attaching harness

Halti

Slip lead

Martingale collar

Choker chain collar

Prong collar

Off lead

Not Applicable

What can your dog do when requested? *

Look

Sit

Down

Stay

Come when called

Touch

Shake

Wait

Give

Leave

Go to bed/mat

Nothing

What training techniques have you tried? *

Rewards - treats, pats, attention

Clicker

Ignoring

Time out

Loud/stern voice

Citronella collar

Shock or electric collar

Clapping hands

Tap across nose

Spraying water

Alpha roll or pinning down

Force

None

How often does the dog growl or snarl at people? *

Never

Rarely

Sometimes

Often

Frequently

How often does the dog growl or snarl at other dogs? *

Never

Rarely

Sometimes

Often

Frequently

How often does the dog snap at people? *

Never

Rarely

Sometimes

Often

Frequently

How often does the dog snap at other dogs? *

Never

Rarely

Sometimes

Often

Frequently

How often does the dog bite people? *

Never

Rarely

Sometimes

Often

Frequently

How often does the dog bite other dogs? *

Never

Rarely

Sometimes

Often

Frequently

Has the dog ever held on and shaken or given multiple bites to a person? *

Yes

No

Has the dog ever held on and shaken or given multiple bites to another dog? *

Yes

No

Has the dog ever held on and shaken or given multiple bites to another animal? *

Yes

No

Has the dog ever caused serious, major or life threatening injuries to a person? *

Yes

No

Has the dog ever caused serious, major or life threatening injuries to another dog? *

Yes

No

Has the dog ever caused serious, major or life threatening injuries to another animal? *

Yes

No

Has the dog ever killed a person or animal? *

Yes

No

Have you or the dog been reported or had legal action taken against them, relating to the dog? *

Yes

No