|
If you are having behaviour problems with your dog and live around or in the Sun Valley or Magic Valley area, please either print out this Questionnaire and mail it to:
Or email it to dj_833522@yahoo.com
I will then look it over and set up an appointment for a private lesson between us. If you are not from around here and are having behaviour problems with your dog you can email me and I will help you as much as possible or try an find a trainer near you to help you. With out being able to see the dog I won't be able to give you much advice because things could easily go wrong. Though if you are willing to video tape exactly what the dog is doing and send it in to me, I will watch it and see if I can't help you then.
Owner Information Name:
Address:
Home Phone:
Work Phone:
Email:
Pet Information
List any medications pet is taking currently: Does the pet have any current medical problems? If so please list: Neutered: Y/N Age Neutered: Where did you obtain this pet? Age obtained: Breeder (if applicable): Behavior of parents or littermates (if known): For what purpose was this pet obtained? Nutrition Type of food: How often is your pet fed? When fed? Where fed? Who feeds? Describe eating (e.g. picky/voracious, etc): List all treats given and frequency: Favorite treats: List any supplements and frequency: Exercise Type of exercise: Amount and frequency of exercise: Who exercises dog? Amount/frequency of play: Who plays with dog? Favorite game: Favorite toy: Describe where dog stays at each of the following times:
How long is the dog home alone each day? Dog's reaction when left alone? Reaction prior to departure? Reaction at homecoming? Is the dog ever alone outdoors? How often? How long is the alne outdoors (Average): What is the longest that you leave your dog alone outdoors? Where is the dog left when outdoors? How does your dog react to car rides? Do you ever leave your dog alone in the care? How long? Principal complaint (It is not necessary to duplicate previous answers). What is the primary problem?: Describe the severity of the problem: mild/moderate/severe Have you considered euthanasia?
Describe the problem beginning with the most recent incident: - Describe previous incidents: What age was your pet when this problem started?: Describe the first incident: How often does the problem occur? Has there been a recent change in frequency or severity?
Describe any changes in the home when the problem first appeared: Have you actually seen the problem?
What has been done so far to try and correct the problem? What was the dog's response? List any techniques that have had success: List any techniques that have made the problem worse: List any drugs tried and the dog's response to the medication: What do you think is the reason for your dog's problem? Additional comments on principal problem: - - Family/Relationships List each family member (including sex and age): - Describe how your dog gets along with each family member: Briefly describe the family schedule, including how long the dog is left alone: - - List all other pets, including species, breed, age and sex: - List all other pets, including species, breed, age and sex: Describe how your pets gets along with each other: - Training Describe any obedience training: At what age did classes begin? Outcome? Describe your dog's learning ability: Who took the dog to training: What commands are most successful? In what location/situations are commands most successful? What commands are least successful? In what location/situation are commands least successful? Which family member(s) have best control? Which family member(s) have least control? Describe your dog's personality: Handling How does your dog react to the following:
- How does your dog react to?
- Crate Training Have you ever used a crate for confinement?_____ If yes, when? Do you still use a crate? How long was the crate used? When and why did you stop (if applicable)? Describe the dog's reaction to beeing crated: Was the crate ever used for punishment? Crate location: Describe crate: Punishment How does your dog react to the following:
What punishment is most effective? Does any punishment make the problem worse?
Which family member(s) is most successful at punishment?
Which family member is least successful with punishment?
Aggression Data Is your dog aggressive to family members? If yes, who?
List any people that your dog is aggressive toward: List any types of people (children, delivery people..etc..) that your dog is aggressive toward: Has your dog ever bitten hard enough to break the skin or cause injury?
Describe any other situations where your dog growls: Does your pet ever threaten or act aggressive in any of the following situations:
If yes to any of the above, indicate which and describe: Is there a particular type of handling that leads to aggression (grooming, trimming nails, giving meds, etc...)? Was there an illness or health problem when the aggression started? Does handling a particular part of the body lead to aggression? When your dog is aggressive, what is your response? Does your pet act fearful at the time of aggression?
Other Problems Answer yes or no, if yes please provide additional information: Masturbation: Roaming: Mounting: Urine Marking: Chews/licks self:
Tail biting: Tail chasing: Fly chasing: Uncontrollable urination when excited: Uncontrollable urination when frightened: Bedwetting (while sleeping): Eats nonfood items: Licks objects: Sleep disorders: Excitablity: Overactive: Phobias (thunder, cars, etc.) Shyness/timidity:
Destructive digging: Destructive chewing: Barking: Howling: Whining: House soiling (stool): Stool eating: Chasing objects: Jumps up (on guests): Jumps up (on owners): On furniture when not permitted: Garbage raiding: Food stealing: Pushy-wants own way: Disobedient:
|