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Canine Behavior Assessment

Home » Canine Behavior Assessment

Canine Behavior Assessment

Step 1 of 7

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Client Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
Phone*
Best time to contact
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Pet Name
Breed
Weight
Age
Sex
- Male
- Neutered Male
- Female
- Spayed Female
Any changes after neutering?
Where did you obtain this pet?
Breeder (if applicable)
Behavior of parents or litter mates
Currently on medications?

For what purpose did you get your pet?
- Companion
- Show
- Breeding
- Working
Age obtained
Type of food
Amount fed
When, where, and how frequently fed? Any comments about eating behaviors?
Supplements given
Favorite game
Types of exercise
Amount/frequency of exercise
Amount/frequency of play
Favorite toy

Describe where your pet stays during the daytime (owner away):
Describe where your pet stays during the daytime (owner home):
Describe where your pet stays at nighttime
Describe where your pet stays when guests visit
How long is the dog alone each day?
Dog's reaction when left alone
Dog's reaction prior to departure
Dog's reaction prior to homecoming
How long left alone outdoors (average)?
Where is the dog when outside?
Fenced in back yard
- Yes
- No
How does the dog react to car rides?
Is your dog ever left alone in the car?
- Yes
- No
If yes, how long?

List each family member, including sex and age.
Which family members have the best control?
Which family members have the least control?
List all other pets; include breed, age, and sex
Describe how your dog gets along with the others

Has your dog attended obedience training?
- Yes
- No
Was obedience training successful?
- Yes
- No
Where?
What can your dog do on command?
Have you ever used a Gentle Leader?
- Yes
- No
Briefly describe your dog's personality
How does your dog react to nail trimming?
How does your dog react to ear cleaning?
How does your dog react to giving medication?
How does your dog react to grooming/bathing?
How does your dog react to patting their head?
How does your dog react to rubbing their belly?
How does your dog react to being lifted?
How does your dog react to rolling over?
How does your dog react to grasping the collar?
How does your dog react to familiar dogs ON property?
How does your dog react to familiar dogs OFF property?
How does your dog react to new dogs ON property?
How does your dog react to new dogs OFF property?
How does your dog react to strangers ON property?
How does your dog react to strangers OFF property?
How does your dog react to strangers arriving indoors?
How does your dog react to other animals?
Has your dog been crate trained?
- Yes
- No
Do you still use the crate?
- Yes
- No
Crate type
Crate location

Describe punishments used, whether physical, noise, water sprayer, verbal, or other
Has any punishment made the problem worse?
List any other people your dog is aggressive toward
Has your dog ever bitten hard enough to break the skin or cause injury?
- Yes
- No
Does your dog ever bark threateningly?
- Yes
- No
Describe any other situations where your dog growls or acts aggressively
Does your pet ever threaten or act aggressive in any of the following situations? (check all that apply)
- Petting
- Chewing objects
- Punishment / Discipline
- People entering yard
- Other dogs on property
- Other dogs off property
- People entering home
- People off property
- When sleeping
- While eating
If yes to any of the above, describe
Was there an illness or health problem when the aggression started?
When your dog is aggressive, what is your response?

Does your pet act fearful at the time of aggression?
- Yes
- No
What is the primary problem (aggression, house soils, destructive, barking, etc)?
How would you describe the severity of this problem?
- Mild
- Moderate
- Severe
Have you considered euthanasia?
- Yes
- No
Describe the problem beginning with the most recent incident
What age was your pet when this began?
Describe the first incident
How often does this problem occur?
Has there been a recent change in frequency or severity? If yes, describe
Were there any changes in the home when the problem first appeared?
Have you actually seen the problem? If yes, what did you do?
What has been done so far, to try and correct the problem?
What was the dog's response?
List any techniques that have had any success
List any techniques that have made the problem worse
If drugs have been used, what was the dog's response to the medication?
What do you think is the reason for your dog's problem?
Additional problems
- Destructive digging
- Destructive chewing
- Barking
- Howling
- Whining
- House soiling - urine
- House soiling - stool
- Stool eating
- Chasing
- Jumps up (owners)
- Jumps up (guests)
- On furniture where not permitted
- In rooms where not permitted
- Garbage raiding
- Food stealing
- Pushy (wants own way)
- Won't come when called
- Mounting
- Urine marking
- Chews/Licks self
- Tail biting
- Fly chasing
- Uncontrollable urination (excited)
- Uncontrollable urination (frightened)

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Location Hours

Monday	8:00am – 7:00pm
Tuesday	8:00am – 7:00pm
Wednesday	8:00am – 4:30pm
Thursday	8:00am – 7:00pm
Friday	8:00am – 4:30pm
Saturday	8:00am – 3:00pm
Sunday	Closed

Winslow Animal Hospital 640 Sicklerville Rd. Sicklerville, NJ 08081 Pet Care You Can Trust

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