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Canine Behavior History




Please complete this form with as much details as possible at least 2 days prior to the appointment. Please videotape your pet performing the behavior(s) before your visit, if possible. For safety reasons, any dog with a known history of aggressive behavior must wear a basket muzzle upon entrance to the hospital. Thank you and we look forward to working with you and your pet(s)!

Client Information

Dog Information

Sex *
Neutered/Spayed *

Referring Veterinarian Information

Chief Complaint

Dog's Environment

Early History

Education

Who trained your dog? How well does your pet obey each person? Please rate your dog’s obedience for each command.

Trainer #1









Trainer #2









Trainer #3









Feeding

Sexual and Maternal

Grooming

Social

37. How does your dog act with:

Learning

Sleep

Medical

Aggression

1. Does your dog show any aggression (growling, snarling, snapping, biting) towards: (select all that apply)
Who has been bitten, what was the context, and where on the body / how severe was the injury (if contact was made; e.g. bruised, broke skin, and drew blood, # of stitches required):

For the following questions and situations

If your dog has no reaction; check the “No Reaction” box, or if the situation never happens check N/A.

If your dog does have a reaction, please use the following words to describe the reaction:

Barks (BK), Growls (G), Snarls (SL), Snaps (SP), Bites (B), Chases (C), or other (clarify).

Please use the following characteristics when describing the reaction:

- Growling = rumble with mouth closed and teeth not showing
- Snarling = rumble with teeth showing, mouth closed or open
- Snapping = teeth close rapidly together without contacting target
- Biting = teeth closed rapidly together and contact target. May or may not leave marks.

Situation

Owner reaches over dog

Type of Reaction *

Owner reaches for dog's face

Type of Reaction *

Owner stares at dog

Type of Reaction *

Owner reprimands dog physically

Type of Reaction *

Owner reprimands dog verbally

Type of Reaction *

Owner attempts to approach/take away dog's food

Type of Reaction *

Owner attempts to approach/take away dog's toy

Type of Reaction *

Owner walks past dog

Type of Reaction *

Owner runs past dog

Type of Reaction *

Dog does not allow owners to move freely through the house

Type of Reaction *

Dog aggressive only when particular family member present but not aggressive toward that family member

Type of Reaction *

Stranger reaches over dog

Type of Reaction *

Stranger stares at dog

Type of Reaction *

Stranger comes to door

Type of Reaction *

Stranger enters yard while owner present

Type of Reaction *

Stranger enters yard while owner not present

Type of Reaction *

Preferred owner holds dog on leash while stranger approaches dog off property

Type of Reaction *

Non-preferred owner holds dog on leash while stranger approaches dog off property

Type of Reaction *

Stranger approaches off leash

Type of Reaction *

Another dog mounts hind end of your dog

Type of Reaction *

Another dog stares at your dog

Type of Reaction *

Another dog attempts to approach/take away dog's food

Type of Reaction *

Another dog attempts to approach/take away toy

Type of Reaction *

Dog does not allow other dogs to move freely through the house

Type of Reaction *

Dog aggressive to other dogs only when family members present

Type of Reaction *

Another dog attempts to play with your dog

Type of Reaction *

Another dog approaches when your dog is on leash

Type of Reaction *

Another dog approaches when your dog is off leash

Type of Reaction *

Dog aggressive after acting submissive to another dog

Type of Reaction *

Dog sees cat indoors

Type of Reaction *

Dog sees cat outdoors

Type of Reaction *

Dog sees squirrel

Type of Reaction *

Dog sees other small animal

Type of Reaction *

Severity of Problem

Please check the option that applies: