Canine Behavior History Form Continued

Has your dog ever attended a training class or had a trainer come to your home? If so, please give details (when, where, age of dog, who trained dog

What skills did you work on with the trainer or class?

What method of training was used (i.e. clicker training, leash corrections, special collars, etc.)?

Please list all behaviors (sit, down, shake, etc.) that your dog has been trained to offer?

Have you done any specialized training with your dog (i.e. agility, tracking, fly ball)?

Who in your family is the primary trainer?

Reinforcers are things your dog loves (like treats, toys, play, or even attention from you). Please list your dog's reinforcers in order of the value they hold for him/her with #1 being their absolute favorite.

Where is your dog when alone in the house?

How does your dog behave when you leave your home?

Have you used a camera to watch your dog while they are home alone?

How does your dog behave when you return from home?

Does your dog exhibit a fearful response to sudden household noises (example: smoke detector), fireworks, or thunderstorms?

If yes, what behavior(s) does your dog exhibit during these noise events?

Does your dog paw at you or at others? *

Does your dog exhibit aggressive behavior over resources?

If yes, what are the resources? (ex. Food, toys, human attention, etc.)

Whom does your dog exhibit this behavior towards? (ex. Family members, other pets in home, etc.)

How does your dog act when they see an unfamiliar dog?

How does your dog act when they see a familiar dog (non-housemate)?

Does your dog exhibit aggressive behavior (growl/lunges/snarls/bare teeth/snap/bite) towards you or any of your family members when handled?

If yes, in what circumstance? (example: petting your dog, trimming nails, handling/picking up, disturb your dog while resting, putting on a collar/harness/leash, etc.) *

Has your dog ever shown any aggression towards another dog or cat in your home? If yes, describe in detail.

Can you usually tell what will sets off your dog? Is the aggressive behavior new and uncharacteristic?

Has your dog bitten and broken skin on a person? Please describe each bite incident in detail and the total number of bites (that did or did not break skin):

What are your goals for your dog when working with veterinary behavior nurse?

Any Additional Comments

Canine Behavior History Form
(Continued)

Training

Fear and Anxiety Profile

SEPARATION ANXIETY

NOISE PHOBIA

REPETITIVE BEHAVIORS

HYPER AROUSAL BEHAVIORS

Behavior Profile

BEHAVIOR AROUND RESOURCES

PROFILE TOWARDS UNFAMILIAR PEOPLE

PROFILE TOWARDS UNFAMILIAR DOGS

AGGRESSION PROFILE TOWARDS FAMILIAR PEOPLE (FAMILY MEMBERS)

AGGRESSION TOWARDS HOUSEHOLD PETS

Bite history

Expectations

Canine Behavior History Form (Continued)