Canine Questionnaire

Canine Questionnaire

STEP 2:

Your dog was acquired from: *
Age of dog when he/she came to live with you? *
Have you attended an obedience class before with this dog? * Yes
No
If yes, where?
Does your dog have physical limitations/medical problems? * Yes
No
If so, what?
Is your dog on any medication other than Heartworm? * Yes
No
Number of family members living in the home?
Adults

Children 10 -21 years

Infants ‚ 10 years old

Do you have a specific area of concern with regard to your relationship with your dog?
What are the two most important things you want to accomplish in this class? *
What do you like best about your dog?
Do you crate/kennel your dog when you are not home to supervise? * Yes
No
Do you crate/kennel your dog at night while sleeping? * Yes
No
Is your dog restrained while riding in the car? * Yes
No
Sometimes
How?
How much time do you spend walking your dog on a leash in a day? *
How much time do you spend playing with your dog a day? *
What is your favorite interactive activity with your dog? *
What brand/variety of dry dog food are you feeding your dog? *
How often do you feed your dog a day? * 1 x day
2 x day
What brand/variety of treats are you feeding your dog? Are they soft or hard treats? *
Select any/all behaviors that may apply to your dog:
Jumping
Nipping / Mouthing
Chewing
Aggressive
Digging
Barking
Counter Surfing
Steals Things
House Training
Submissive Urination
Excitement Urination
Separation Anxiety
Shy/Timid
Fearful
Needs Socialization
Doesnít Listen Well
Doesnít Come when Called
Excessive Energy
Pulls on Leash
Pushy / Demanding
Dominant
Destructive
Dog Aggressive
Men / Women / Children Aggressive
Cat Aggressive
Fear Aggressive
Food or Toy Aggressive
Bone or Rawhide Aggressive
Dog has caused aggressive injury
Please describe the behaviors you selected above:
E-mail Address: *
Your Name: *
Your Dogs Name:

* Required

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