Project Reward Questionnaire

Behavior Questionnaire

Some basic information and how we can get in touch with you.

Name: (Required)

Street Address: (Required)

City, State, Zip: (Required)

Daytime Phone: 555-555-1234

Evening Phone: 555-555-1234

Email Address: (Required)

How did you hear about Project Reward?

Dog's Name *

Age *

Breed or size *

What is your dog's sex? *

Is your dog spayed or neutered? *

How long have you had your dog? *
Months - Years -

Where did you get your dog(s)? i.e. Pet shop, breeder, shelter, rescue...*

Including yourself, how many people and of what ages live in your house? *

What other animals does your dog live with? *

Please describe your living situation. i.e. House with yard, condo with walking area, apartment, etc. Please be specific. *

Describe how much time each person in your home spends with the dog and what you typically do together. For example: go for for walks, play games, hang out, etc. Please be specific. *

Where does your dog sleep? *

Describe all electronic fencing, collars, or other electronic corrective devices in use or previously used. *

Is your dog scared of anything? *

Is your dog allowed on furniture? *

What is your dog's daily exercise like? Please be specific. *

What is your dog's favorite game? How long will he/she play this game?

What is/are the thing(s) you like best about your dog(s)?

Has your dog attended any obedience training classes? If "yes", where and when?

What commands does your dog know?

Please describe what it looks and feels like when you go for a walk with your dog.

How does your dog react to unfamiliar men?
Never EncounterFriendlyAfraidShows teeth/growlsSnapsBites

How does your dog react to unfamiliar women?
Never EncounterFriendlyAfraidShows teeth/growlsSnapsBites

How does your dog react to dogs it knows?
Never EncounterFriendlyAfraidShows teeth/growlsSnapsBites

How does your dog react to unknown dogs?
Never EncounterFriendlyAfraidShows teeth/growlsSnapsBites

Does you dog usually attempt to uncontrollable chase or attempt to chase any of the following?
JoggersBicyclesSkateboards/roller bladersCars/motorcyclesOutdoor catsDoesn't chase

How does your dog usually react during grooming? Bathe? Brush? Wipe feet? Nails?

Where does your dog stay when you are out of the house?
Inside the house, runs freeInside the house, in a crateOutside the house, runs free in neighborhoodOutside the house, runs free in yardOutside the house, in a run

Does your dog see a veterinarian at least once a year?

If "yes", please specify the veterinarian name and contact info:

Does your dog wear a muzzle at the veterinarian?

Has your dog ever shown any aggressive behaviors when handled by a veterinarian?

Does your dog have any past or present medical conditions? (If "yes", please describe)

Is your dog currently on any medications or special diet?

What exact brand of food does your dog eat? How much does your dog eat?

Is there any report of your dog ever inflicting a serious bite to a person (such as an attack or a bite requiring hospitalization)?

Has your dog ever attacked another dog resulting in severe injury or death to another dog?

Has your dog ever attacked another domesticated animal species (cats or livestock but not “small pets” like hamsters, guinea pigs, etc.) resulting in severe injury or death to another domesticated animal?

If you checked "yes" in any of the 3 questions above, please explain below.

If your dog has shown aggression towards a man, women, or child in what circumstance has it shown?
Was it over food?Was it over bones or rawhides or chews?Was it over toys?Was it over stolen objects?Was it when the dog was disturbed while sleeping or resting?Was it when the dog was handled (brushing, handling feet, bathing, ear cleaning, etc. but do NOT include reaction to vet or groomer)?Was it when an adult or child entered the home?Was it when an adult or child approached or reached toward dog?No aggression shown.

Please explain the circumstances of the snap or bite. If you checked more than one bite in the table above, please explain the circumstances of every snap or bite.

Are there any other behavior concerns that were not covered in this questionnaire?

Please feel free to tell us any additional helpful comments.

Thank you for taking the time to fill out this information. Your dog's history and current behaviors are very important in our training.

We will contact you ASAP.