INTER DOG AGGRESSION WITHIN A HOME HISTORY FORM

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ANIMAL EMERGENCY & REFERRAL ASSOCIATES 1237 Bloomfield Ave. Fairfield, NJ 07004 (P) (973) 788-0500 (P)(973) 226-3282 Fax: (973) 364-0004 www.animalerc.com Date: Client s name: Pet s name: Pet s age: Pet s breed Pet s sex: M F (circle one) Neutered/spayed? Phone number (home): (work) How can the behavior service contact you during the day to check in on your pet? Primary phone : Secondary phone : Email INTER DOG AGGRESSION WITHIN A HOME HISTORY FORM 1. Please list all dogs who live in your home. Name: Age Now: Breed: Gender: Age when obtained: Neutered/spayed: Dog 1 Dog 2 Dog 3 2. Please list all people who live in your home Name of person Age of person 3. Please describe the three most recent incidents that have occurred between your dogs? a. 1

b. c. 4. Please check all of the words that you feel your dog knows well. Dog s name Sit Down Stay Wait Leave-it Drop-it Go to place/go to bed Dog s name Sit Down Stay Wait Leave-it Drop-it Go to place/go to bed 5. Please check all that apply: When I arrive home: Both dog s are equally pushing each other out of the way to get my attention. One dog is much more pushy about getting my attention but the other dog still tries to get my attention. One dog is more pushy about getting my attention so the other dog momentarily backs a few steps away but within seconds is trying to get my attention again. One dog is much more pushy about getting my attention and the other dog clearly hangs back several feet until I have said hello to the first dog. One dog is more pushy and my other dog no longer gets up to greet me. Other 2

6. Please check all scenarios in which your dogs have shown aggression to one another (aggression = a growl, a snarl, baring teeth, air snap, bite) Over treats being given by a person Over treats left on the ground Over food bowls Over bones Over a person s attention Over dog beds Over furniture (one dog tries to get up on the couch and the other one shows aggression) Between the couch and the coffee table In hallways Going in and out of doorways After being reprimanded After seeing a dog or a person outside When the doorbell rings While the dogs are waiting for a treat/food Over toys Out of nowhere no identifiable cause One dog constantly annoys the other dog Other (please list): 7. Is the aggression worse during the day, afternoon, night, or does the time of day not matter? 8. Are either of your dogs diagnosed with medical problems? Yes No If yes, please list the medical problems for each dog. 9. Are either of your dog s on medication? Yes No If yes, please list the medications for each dog. 10. Have you noticed that one dog tends to take a wide berth around the other dog as opposed to walking straight passed the other dog? Yes No Do not know /Have not noticed 11. What are the most severe injuries sustained because of a dog fight? 12. Which dog receives the most injuries? 13. How long has this problem been going on? 14. Please check all that apply: After a fight; 3

Both dogs immediately calm down and are fine with one another Both dogs continue to remain aroused to the point that we must separate them for a certain time period. One dog calms down immediately; whereas the other dog remains aroused/aggressive One dog calms down immediately; whereas the other dog remains very anxious for an extended time period (greater than 5 minutes). Both dogs appear anxious after a fight for an extended time period (longer than 5 minutes. Other 15. How do you separate the dogs when they are fighting? 16. Have you ever been bitten trying to separate a fight? Yes No 17. When your dogs fight, does the other dog fight back or just yelp and try to get away? 18. Do the dog fights ever end on their own or do you have to intervene in order to get the dogs to stop fighting? 19: Have you noticed that one of the dogs now tries to stay clear of the other dog (or walks on eggshells around the other dog)? Yes No Do not know/have not noticed If yes, please name the dog who is walking on eggshells. 20. In between fights, which best characterized the relationship between your dogs in your opinion: They are best friends. They play together often. They really seem to enjoy each other s company. They do not really play much but they seem to get along well enough. They don t really interact much at all. They appear indifferent to one another. They hate each other. They would prefer to be the only dogs in the house. Other (please explain): 21. If your dogs do play together, do they initiate play equally or does one initiate play more often? 4

22. If you had to describe each of your dog s personality, how would you describe them? 23. Please list each dog s favorite treat? 24. Please list each dog s favorite toy? 25. Do you feed your dog s meals or do you leave food out all of the time for them? 26. Where did you get this dog? Circle one): Shelter Breeder Friend Pet Store Stray Rescue Organization Other: 27. Describe your dog s behavior as a puppy? 28. Do you have any news about littermate s behavior? Yes No If yes, please describe 29. Did you meet the parents? Yes No If yes, please describe 30. Has this dog had any other owners? Yes No If yes, how many? 5

31. Has your dog ever growled/snapped/or bitten a person? Yes No If yes, In what general circumstances does your dog show these behavior towards people? 32. What do you feed them? 33. Please list all other behavior problems that each of your respective dogs have: 34. Is your dog on any herbal, homeopathic, or nutritional supplements? Yes No If yes, please list 35. Please check the answer that best describes how you feel about the current situation: I am here only out of curiosity- the problem is not that serious. I would like to change the problem, but it is not serious. The problem is serious and I would like to change it, but if it remains unchanged, that is all right. The problem is serious and I would like to change it, but if it remains unchanged I will keep my dog. The problem is very serious and I would like to change it; if it remains unchanged I will have to consider finding another home for him/her or euthanizing him/her. 36. Which statement(s) best represents how you feel about the use of medications for your pet s behavioral issue(s). Please check as many answer choices as you wish. I am strongly opposed to the use of psychoactive medication and simply will not use them. I will only use medication as an absolute last resort. I would rather try nutritional supplements, herbs, etc.first. I would rather not use medications to treat my pet s problems, but I am open to hearing about them along with nutritional, herbal etc. options. I am open to any treatment option as long as it will help my pet. VIDEO: If you are able to bring video of your dogs interacting that will allow me to help you in fewer appointments. Please note that I do not need you to capture a fight but rather capture video in a few scenarios where they be walking by one another, hanging out in the same room, how they are as they are waiting to be fed etc..even if you think the video is boring and shows nothing, I often see lots of helpful subtle behaviors that give insight into the problem. End of questionnaire. Thank you! Please fax, email, or mail this form to Animal Emergency & Referral Associates. Contact information on page 1. 6

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