Dog Behavior Intake Form
Collects dog and owner history, health, behavior, and training information.
Date
/
/
Owner Name
Cell Phone
Email
Address
City
State
ZIP Code
Dog Name
Breed Mix
DOB Or Age
Weight
Color Or Unique Markings
Sex
A
Male
B
Female
Reproductive Status
A
Intact
B
Neutered Spayed
If Spayed Neutered At What Age
Housing Type
A
House
B
Townhome
C
Apartment
D
Other
Fenced Yard
A
Yes
B
No
Invisible Fence
A
Yes
B
No
Where Did You Obtain Your Dog
A
Breeder
B
Individual
C
Shelter
D
Rescue Group
E
Pet Store
F
Friend Relative
G
Found Stray
H
Other
How Long Have You Had Your Dog
Previous Owners
If Yes Why Was Dog Given Up
Dog Identification Type
A
Microchip
B
Rabies License Tag
C
Name Tag
D
Tattoo
E
Other
Why Did You Get Your Dog
A
Companionship
B
For The Kids
C
For Protection
D
To Breed
E
Received As Gift
F
Sports Work
G
Assistance Service Therapy Emotional Support
H
Companion For Other Dog
I
Other
Have You owned other dogs In the past?
If Yes What Breeds
Veterinarian Name
Veterinarian City
Current Health Problems / Medications
Allergies Including Food Allergies
Easily Handled By Vet Staff
A
Yes
B
No
Ever Had To Be Muzzled
A
Yes
B
No
On Heartworm Preventative
A
Yes
B
No
On Flea Tick Preventative
A
Yes
B
No
Favorite Foods Treats
Possessive Of Food Or Treat
A
Yes
B
No
Reliably Housetrained
A
Yes
B
Mostly
C
No
Crate Trained
A
Yes
B
No
Dog Door
A
Yes
B
No
Exercise Type
Exercise Duration And Frequency
Who Exercises Dog
Reactive On Walks
A
Yes
B
No
Family Members Living With the Dog
Name
Gender
Age
Relationship to you
Who Will Practice Training Exercises
Where Dog Sleeps At Night
Sleeps In A Crate
A
Yes
B
No
Hours Without Human Companionship Per Day
Plays With Toys Or Games
A
Yes
B
No
Other Activities Dog Enjoys
Things I Like About My Dog
Things I Would Like To Change
Training History
A
No Training Yet
B
Trained Him Ourselves
C
Puppy Group
D
Basic Group
E
Intermediate Group
F
Advanced Group
G
Private Lessons
H
Sent To Trainer
Training Methods Used
A
Food Treats
B
Praise
C
Verbal Corrections
D
Physical Corrections
Behaviors Dog Knows
A
Down
B
Stay
C
Come
D
Walk Nicely On Leash
E
Leave It
F
Give
G
Wait
H
Quiet
I
Off
J
Sit
K
Bed / Place
Other Tricks
Behavior Concerns
A
Aggressive
B
Fearful
C
Anxious When Alone
D
Jumps On People
E
Pulls On Leash
F
Destructive When Alone
G
Mouthing Nipping
H
Chews Furniture Property
I
Digs In Yard
J
Urinates In House
K
Urinates When Excited
L
Defecates In House
M
Steals Food Objects Trash
N
Darts Out Doors Gates
O
Escapes From Yard
P
Guards Food Toys Chewies
Q
Excessive Attention Seeking
R
Jumps On Furniture
S
Play Biting
T
Stool Consumption
U
Understands But Will Not Obey
V
Excessive Vocalization When Alone
W
Excessive Vocalization When Home
X
Other
Z
Threatening Biting Family Members
Y
Threatening Biting Strangers
A
Threatening Growling At Other Animals
Dog Has Bitten Anyone
A
Yes
B
No
Dog Has Bitten An Animal
A
Yes
B
No
Bite Details
Medical Attention Needed After Aggressive Incident
A
Yes
B
No
Medical Attention Explanation
Reaction To Unfamiliar Person Entering Home
Help Needed In Order Of Importance
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