Happy Tail Dog Training LLC Colleen Griffith, Managing Member Canine Behavior Modification Consultation
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- Alisha Freeman
- 5 years ago
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1 Client Behavior History Form Happy Tail Dog Training LLC Please complete the questions below as best as you can. Canine behavior is complex; hence, this questionnaire is designed to help me understand as much as possible about your dog s temperament, experiences, and living environment. The more information you re able to include in this form, the more cost-effective I ll be able to make your session(s). Please add any additional information you feel is pertinent. If you d like a Word version of this document so you can edit it electronically, inform Colleen and she ll provide it for you. Name: Address: City/State: Phones (Home): Zip: (Cell): Dog's Name: Age: Gender: Weight:! How long have you had the dog?! Dog s age when acquired?! What is your dog s breed and where did you get him/her? Spayed/Neutered?! Number of adults in household:! How many children in household, include ages:! List other dogs in household, include ages:! List other pets in household, include ages:! Your experience level with dogs in general: If yes, at what age? First time owner Somewhat experienced Experienced! Your experience level with this particular breed, or a similar breed of dog: First time owner Somewhat experienced Experienced! Veterinarian, include contact information: Colleen@HappyTailDogTraining.com, (cell) Pg 1 of 6
2 ! List any medications your dog is taking (including dosages), as well as any health issues! Please list any allergies to food or medications. Please include his/her current vaccinations:! Please include his/her current vaccinations, including Rabies:! Please describe all of your dog s unwanted behaviors (i.e., behavior problems) and go into as much detail as you wish. Please feel free to use as much space (or extra paper) as necessary and please also describe what these behaviors look like.! When were the unwanted behaviors first noted?! How often and under what circumstances do the unwanted behaviors occur?! When (under what circumstances) do these unwanted behaviors NOT occur?! What has been done so far to correct the problem(s)? Type of discipline, confinement, training...! What was the dog s response to these corrective measures? Check other behaviors which might apply to your dog s current, or fairly recent, behavior: Not housetrained Jumps Up Pushy Escapes Food Thief Unruly Shy Aggressive to dogs Barks Doesn't Obey Defensive Aggressive to people Digs Runs away Fearful Aggressive at vet Howls Chases Anxious Fearful/shy at vet Mouthy Eats stool Nervous Handling issues: nail trims, looking in ears Destructive Chewing Eats junk Demanding Colleen@HappyTailDogTraining.com, (cell) Pg 2 of 6
3 ! List any books and TV shows on the topics of training, canine behavior & social development that you ve read or watched:! Have you consulted a behavior specialist or taken any training classes (including obedience, tricks, etc) with your dog?! What will your dog do on command/cue?! What equipment do you use with your dog when AWAY from home, such as on the walk (prong collar, choke chain, shock/vibration collar, head halter, front clip harness, etc)?! What equipment do you use with your dog when IN your home?! Have you conditioned your dog to wearing a muzzle?! Were does your dog sleep?! Is your dog crate trained? If yes, how many hours/day does he spend in his/her crate?! Describe your dog s behavior when traveling in the car (describe what it looks like, for example, sleeps, watches and barks out the window)?! How often do you feed your dog? Once daily Twice daily Free feeding! What type of food? Does your dog have any known food allergies or is (s)he on a restricted diet?! Who exercises with your dog? Also, what kind of exercise (type and number of hours) does your Colleen@HappyTailDogTraining.com, (cell) Pg 3 of 6
4 dog get on a daily basis? On a weekly basis?! Does your dog go to daycare or have a dog walker? Please describe your home setting by checking all that applies: House Yard If applicable, list type of fence and height here: Apartment Dog Door Townhouse/Condo Fence Other (Please explain at right)! How long is your dog left alone each day and where does (s)he spend that time?! How does your dog react to being left alone (Check all that apply): My dog is relaxed when left alone Will move from room to room with you when you move Will sometimes be in a different room by his/her own choice Whines or barks when left alone Provide any additional detail or information here: Destroys household items while you are at home Destroys household items when you are gone Does not destroy any inappropriate object! What makes your dog bark?! Is your dog over-protective of any of the following? If yes, please explain below: Food (with family, others, or dogs) Property (with family, others, or dogs) Toys (with family, others, or dogs) You or another person! If you answered yes to any of the above questions regarding being overprotective, please explain in further detail here: Colleen@HappyTailDogTraining.com, (cell) Pg 4 of 6
5 ! How does your dog react to others (please check all that apply) When LEASHED and AWAY from home When OFF-LEASH and AWAY from home When at home Strangers Strangers Strangers Fearful and/or Shy Fearful and/or Shy Fearful and/or Shy Playful Playful Playful Disinterested Disinterested Disinterested Adults Adults Adults Fearful and/or Shy Fearful and/or Shy Fearful and/or Shy Playful Playful Playful Disinterested Disinterested Disinterested Children Children Children Fearful and/or Shy Fearful and/or Shy Fearful and/or Shy Playful Playful Playful Disinterested Disinterested Disinterested Please add any additional information you feel is pertinent here:! Has your dog ever bitten anyone? Or has your dog s teeth ever come into contact with the clothing or skin of another person? If you answer yes to either of those questions, please explain the circumstances and any damage done (i.e., bruising, broken skin, torn clothing) below. Colleen@HappyTailDogTraining.com, (cell) Pg 5 of 6
6 ! Do you currently take your dog to dog parks? If so, how often? Also, if applicable, do you know whether your dog played at dog parks, prior to adopting him/her? If so, how often? Frequently Occasionally One or two times Never! If applicable, do you know if your dog played at dog parks prior to you adopting him/her? If so, how often? How does your dog react to other dogs (Check all that apply): Plays nicely with all dogs (s)he has met Plays nicely with most dogs, but does not like certain dogs Plays nicely, but can become over-excited and too rough at times Greets other dogs, but isn t interested in playing with them Provide any additional detail or information here: Tries to avoid contact with other dogs or snaps for no apparent reason at other dogs or snaps as a correction for another dog s behavior Can not be off-leash or interact for extended periods of time with other dogs! Has your dog ever been attacked by another dog? If so, at what age?! Has your dog ever attacked another dog or been in a fight with another dog or animal? If you answer yes to either of those questions, please explain the circumstances and any damage done (i.e., bruising, broken skin).! List three (or more) activities that your dog likes/loves:! List three (or more) foods that your dog absolutely LOVES:! What are your goals for this dog? Colleen@HappyTailDogTraining.com, (cell) Pg 6 of 6
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Dog Daycare. Pet Profile Enrollment Form. K-9 Kamp Downer Street Rd. Baldwinsville, NY Phone:
K-9 Kamp Dog Daycare Pet Profile Enrollment Form Please return this completed form along with a copy of your pet(s) vaccination records to: K-9 Kamp 228 Old Bridge Street East Syracuse, NY 13057 -OR- 2115
Surrendered Misc. Pet Information
Surrendered Misc. Pet Information Animal Code: Pet Name: Spayed/Neutered? Y N I want to be notified if the Placer SPCA is unable to place this animal for adoption. (There is a $25 non-refundable fee for
Adoption Application
CONTACT INFORMATION Name: Address: Phone: Email: Are you a current or former WagsInn customer? Yes No HOUSING Do you live in a house, condo, apartment, or townhouse? Do you rent or own? If you rent, please
2 nd Pet Enrollment Application
2 nd Pet Enrollment Application GENERAL INFORMATION Human Name: Spouse name: Email: Home phone: Cell: CANINE INFORMATION Name: Breed: Weight: Birth date: Male/Female: Neutered/Spayed: Color: Markings:
Cat Profile. Animal ID (Staff Use Only) Cat s Name: Breed: Spayed or Neutered: (Check Box) Yes No Unknown Age: Date of Birth (If Known):
Date: / / Cat Profile Cat s Information: Animal ID (Staff Use Only) Cat s Name: Breed: Sex: (Check Box) Male Female Spayed or Neutered: (Check Box) Yes No Unknown Age: Date of Birth (If Known): Declawed:
Behaviour Questionnaire
Behaviour Questionnaire Client Details Patient Details Owner to please complete this form and return to Murray Bridge Veterinary Clinic In order to help us with a diagnosis for your pet both background