Canine Behavioral History

Name(Required)

First

Last

Phone(Required)

Email(Required)

Are you a current client?(Required)

Yes

No, please contact me to schedule a visit to establish care

Do you have a behavior consult scheduled?

Yes

No, please contact me to schedule

Other

What is the date and time of your scheduled behavior consult?

What is the best phone number to reach you at?(Required)

Who referred you to us?(Required)

Dog's Name(Required)

What is your dog's age and date of birth (or rescue day)?(Required)

How did you acquire your dog and do you have a history of previous care (bought from a breeder at 8 weeks, adopted at 3 years old without previous history, etc)?

Please tell us about any other pets who live in the home (age, sex, neutered, relationship with other pets e.g. plays, fights, ignores).

What tricks can your dog reliably perform (sit, come, touch)?

Does your dog enjoy playing games with you (e.g. fetch, tug)?

All the time

Sometimes

Never

Unsure

How and when do you feed your pets (eg. twice a day in their kennels, once daily with everyone's bowls in the kitchen, etc)?

How is your dog's appetite?(Required)

Always hungry, will eat anything and everything

Will finish meals, enjoys high value treats like meat and cheese but not lower value treats like dry biscuits

Finicky, frequently does not complete meal and only eats really tasty treats

What does a typical work day look like for your dog (how many hours spent alone, outside, in crate)?(Required)

What does a typical weekend/free day look like for your dog (exercise, training, other activities)?(Required)

Does your dog have any concerns with the following? (Select all that apply)(Required)

If your dog has any behavior concerns marked above, please elaborate (what is your dog's response, when did the problem start, how often and under what circumstances does your dog respond this way?):(Required)

What are your top 3 concerns about your dog's behavior?(Required)

When did each concern begin and in what situations does it occur?(Required)

What methods have you tried in order to solve your pet's behavioral concerns? (Select all that apply)

What was your dog's response to each of the above methods you have tried (improved, stayed the same, worsened)?(Required)

Has your dog ever bit or nipped anyone? If, so did this bite require medical attention?(Required)

Does your dog need to be leashed, muzzled, or placed in another room when visitors enter the house?

Yes

Maybe

If the behavior problem does not improve, or worsens, have you considered re-homing or euthanizing your dog?(Required)

Does your dog have any past or current medical concerns?(Required)

What medications (dose and frequency) is your dog currently taking (including names and strengths, nutraceuticals, herbs, and over the counter supplements)?(Required)

What flea/tick/heartworm products is your dog currently taking?(Required)

What is your goal for this appointment?(Required)

Please tell us anything else about your dog or household that you think is important for us to know before our appointment.(Required)

Does your dog have any food restrictions? If so, please let us know what treats (if any) we may use during the appointment.(Required)

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What's Next

Call us or schedule an appointment online.

Meet with a doctor for an initial exam.

Put a plan together for your pet.

Where family pets find loving care