Intake Behavior Questionnaire - The Dog Connection

In a few sentences, describe what prompted you to reach out to The Dog Connection and tell us about your goals:*

I understand to complete this form *separately* for each dog whose behavior we will be assessing.

Check the box if true

Dog Name:*

Dog Date of Birth:*

Breed:*

Neutered/Spayed (if so, when):*

Weight:

How did your dog come to join the family?*

When did your dog join the family?*

At what age did your dog join the family?*

Any known behavioral/environmental history prior to joining your family?*

What do you love most about your dog?*

What is your Occupation:

What is your work schedule, at home or away from home?

Are you the legal owner of the dog?*

Yes

No

Who is/are the primary caretaker(s) of the dog?*

List all human residents by name, age and relation:*

List all animal residents by name, species, age and when they joined the family:*

Relationship dynamics (select all that apply):

Veterinarian:*

Date last seen by vet:*

Current medical concerns or conditions:*

Current Medications + prescribed dosage and frequency:*

Have you ever spoken with your vet about behavioral concerns? If so, what was their feedback>?

Has your dog ever been on behavioral medication?*

Yes

No

If so, what medication, dosage and frequency? How long did they take it? Why was it prescribed? Did it have the intended effect?

List any environmental, medication or food allergies:*

Past medical procedures or conditions (e.g. had parvo as a puppy, or ACL surgery at 18 months):*

What does your dog eat for meals? How much and how often?*

Does your dog eat meals quickly, moderately or slowly?*

Does your dog eat out of a bowl, slow feeder, or enrichment toy?*

What treats and snacks does your dog love the most?*

How much sleep do they get at night?*

Where do they sleep overnight?*

How much sleep do they get throughout the day?*

Where do they like to nap?*

What are your dog’s favorite enrichment activities:*

If you selected other, explain:

What does a typical day look like for your dog, from the time they wake to bedtime?*

Home type:*

At home/daily outdoor access: fenced private/shared yard, unfenced green space, on leash city walks*

Have there been any recent changes in the environment (e.g. moving, schedule changes, a human or animal moving in or out of the home, a loss in the family, etc.)?*

Have there ever been any changes in the environment that have had a significant impact on your dog?*

Are there any expected upcoming changes in the environment?*

Would you like to improve your leash walking skills?*

How would you describe your dog's leash walking skills?*

Do they react to people, dogs, critters, vehicles, objects, noises, etc.? Explain briefly.*

Does your dog enjoy, tolerate or fear riding in a vehicle?*

Does your dog have dog friends? If so, what does their time together look like?*

Does your dog enjoy, tolerate or fear/dislike meeting new dogs?*

How many people friends does your dog have? What ages (child, young adult, adult)?*

Does your dog enjoy, tolerate or fear/dislike meeting new people?*

Have there been any recent changes in your dog’s behavior?*

Any changes in sleep, appetite, activity level, playfulness, cuddly/clinginess, noise sensitivity, etc?*

If yes, describe briefly:

Does your dog exhibit signs of fear, anxiety or stress? If yes, describe briefly.*

Does your dog exhibit hyper-aroused, overexcited or uncontrollable behavior? If yes, describe briefly*

Environmental stressors (select all that apply)*

For each stressor, note how often they are exposed, how they respond/cope and how long it takes them to recover from the stressful event.*

Other Stressors: Explain

Do you believe your dog feels anxious more often than not, regardless of the environmental context?*

Briefly describe any recent traumatic events you/your dog have experienced. List in order by date.*

Briefly describe any past traumatic experiences that you think have shaped who your dog is. List by date/month/year.*

How and how often does your dog exhibit distance-increasing behaviors around PEOPLE (e.g. turning away, walking away, hiding, barking, growling, lunging)?*

How and how often does your dog exhibit distance-increasing behaviors around DOGS (e.g. turning away, walking away, hiding, barking, growling, lunging)?*

Has your dog ever bitten a human adult or child?*

Yes

No

Has your dog ever bitten another dog or other animal?*

Yes

No

If yes, please explain: what happened, how it started, duration of the conflict, how it resolved, # of bites/punctures, medical attention required (if any), and location of bite*

Briefly describe your dog's training history:*

What cues (sit, down, come, etc.) does your dog know well?*

What are your hobbies?*

What are your dog’s top 3 favorite things in life?*

Tell us about your favorite activities you do with your dog?*

Please provide any pertinent arrival/access/parking Instructions:*

What does a typical introduction look like when a new guest comes to your home and meets your dog?*

Is there any additional information you would like to provide prior to our consultation?*