Dog Consult Questionnaire

Pet Owner Information

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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Who can we thank for referring you to Shake It Off Dog Training?

Please list the other HUMANS with whom you share your home. Include their NAME(S) and AGE(S).

Pet Information

Dog's Name

My dog is:

Dog's Birthdate (if unknown, list estimated age)

Dog's Age When Adopted?

Dog's Breed

Dog's Weight

Where did you get your dog? Please indicate the particular shelter/rescue, breeder, or if through a friend, as a stray, or from and online ad).

Please list the other PETS who occupy your home, including their SEX, SPECIES and AGE.

Veterinary Information

What veterinarian/veterinary clinic do you use?

Veterinarian's Phone Number

(###)

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When was your dog's most recent vet visit?

Is your dog fully vaccinated and up to date on vaccines (including Rabies vaccine) ?

Is your dog spayed/neutered?

If yes, at what age was your dog spayed/neutered?

Does your dog have a current, or previously relevant, medical condition? Is your dog currently taking any medication? If yes, please explain.

Pet History

Describe your dog's daily routine

What does your dog do for exercise? How often and for how long?

What are your dog's favorite activities? What kind of toys/chews does your dog enjoy? Does your dog like to deconstruct stuffed toys?

What do you feed your dog for meals and when do you feed?

Include brand of food, if it is kibble, freeze dried, raw, canned etc.

Is your dog allergic to any foods?

What are your dog's favorite foods or treats?

Does your dog have dog friends outside of your home that he/she enjoys playing with?

Training Information

Have you, or a former owner, done any previous training (yourself, professional private lessons/group classes)? Can you describe the basic approach that was used (positive reinforcement, rewards based, balanced, assertive/dominance, corrections/aversives)? Did you feel you got the results you were looking for?

Please list your dog's current skills.

(e.g. sit, lay down, recall, walking on leash, stay, shake, bow, go to mat, crate trained, wait at door, drop it, leave it, hand target)

In the order of importance, please list the goals and/or behavioral issues for which you seek assistance.

If you are experiencing RESOURCE GUARDING, AGGRESSION, or REACTIVITY with your dog, please respond to the below questions. Otherwise you may skip to the next section.

When did the behavior first happen?

When did the behavior last happen?

Please describe ALL previous bite incident(s) in detail.

Include: approximate dates, the dog's actions, context and environment (location of the incident, the animals and humans involved, stressful events that may have occurred earlier that day, etc). Describe the extent of injuries, if any.

Is there anything in your dog's history that you believe may have caused or contributed to the behavioral issue(s)?

What measures have been taken so far to address the behavioral issue(s)? Which of the techniques used have been successful? Which techniques have made things worse?

What is your vision for life with your dog? Is there anything else you'd like to share?