Behavior Questionnaire - Emily Scott | Certified Canine Behavior Specialist

Medical and Health Info
Vet Name*
Vet Contact Info*
Date of Last Vet Visit
MM slash DD slash YYYY
Date of Last Vaccinations
MM slash DD slash YYYY
Date of Last Rabies Vaccination
Is dog on any medications, including homeopathic and heartworm/flea meds?
Please include name of meds and dosages.
How long has dog been on medications?
Any side effects?
Any chronic medical conditions?
Please describe in detail.
What brand/formula is dog being fed and how much and how often?
Any known food allergies?
Any known environmental allergies?
How is dog's appetite? (picky, voracious, normal)

General House Behavior and Routine
Briefly describe your dog’s personality. (outgoing, shy, confident, pushy, fearful, etc.)
What is dog's favorite treat?
What is dog's favorite toy?
Where did you get your dog?
How long have you had your dog?
If rescued, describe known history of dog prior to adoption?
If dog came from a breeder, describe breeder? (backyard, professional)
Was the dog given any socialization as a puppy? (before 6 months)
Is dog crate/kennel trained?
Does dog live indoors and outdoors?
Does dog live outdoors only?
Where does dog sleep?
Describe dog’s daily routine
How often is dog given dedicated daily exercise? (walk, run, swim)
How long is dog exercised daily?
What type of play does dog enjoy?
Does dog enjoy being touched and cuddled?
Does dog follow you around the house?

General House Behavior and Routine (cont)
Are there other pets in the home? (If so please describe)
Describe your dog’s relationship with each pet described above.
Has the dog had any formal obedience training? If so, where and when?
Type of training dog received (traditional, use of food, etc.)
Do you feel training was helpful?
Have you ever used an electric (shock) collar (e-collar, invisible fence, vibration collar or citronella collar) on your dog?
- Yes
- No
If yes, describe how you trained the dog with the e-collar?
Do you feel the e-collar is/was helpful in resolving the behavior issues you were experiencing?
Describe all skills/behaviors that the dog knows (sit, down, etc.):
What behaviors are difficult for the dog and in what circumstances?
What is your dog’s attitude toward training?
Describe dog’s personality when he’s at home.
Describe your dog’s personality when he’s in an unfamiliar environment.
How does your dog behave toward strangers who enter the home?
How does your dog behave toward strangers outside of the home?
How do you manage (control) your dog when strangers come into your home?
How does your dog behave toward older children? (ages 7 and up)
How does your dog behave toward younger children? (ages 1-6)

Human Directed Aggression and Reactivity
Describe all episodes of aggression toward strangers. (this includes any growling, barking, lunging, nipping or biting)
Describe all episodes of aggression toward known family members. (this includes growling, barking, lunging, nipping or biting)
When did aggression start? (Time frame)
Age of dog when aggression started.
If dog has bitten a person please indicate which level of bite
Was animal control involved? If so, describe:
Does dog give any warning before showing aggression?
Is your dog aggression toward people ONLY when on a leash?
Is your dog only aggressive toward people who enter the home or yard?
What have you done to correct the behavior?
Why do you think your dog is exhibiting this behavior?

Dog Directed Aggression and Reactivity
Describe your dog’s history with socialization with other dogs (if known)
Does your dog still socialize with other dogs? If so how often and where?
How does your dog respond when meeting unknown dogs? (On and Off leash)
If dog’s behavior has recently changed around other dogs, please give a timeline of when change happened.
Was there any incident that you can recall that could have contributed to change in your dog’s demeanor around other dogs?
Does your dog show aggression or reactivity toward dogs ONLY when ON leash or behind a fence?
If you dog only reacts to other dogs when on a leash, describe his behavior when he sees another dog and how far away the dog is when your dog will react.
Describe all incidents where your dog engaged in a physical altercation with another dog (include location, age and gender of the other dog)
What was the age of your dog when the aggression started?
Rate the severity of your dog’s aggression toward other dogs. (Mild, Moderate, Severe)
Has your dog bitten another dog? If so, explain the level of bite – bruising, nipping, puncture, grab-shake, rip, Death of other dog?
Was Animal Control involved? (If so describe)
What have you done to correct the behavior?
Why do you think your dog is exhibiting the aggression or reactivity toward other dogs?

Resource Guarding
Has your dog ever growled or snapped at you over a toy or valued item? If so, describe what he/she does.
If so, what items does your dog guard? (note: dogs can guard toys, food items, stolen items, space like a bed or couch, locations in a house, as well as people)
Has the dog ever bitten a person when guarding a resource? If so describe incident(s)
Does the dog give warning before he shows aggression? (Hard stare, showing teeth, growling, snapping)
Has your dog ever growled or snapped or gotten into an altercation with another dog over a resource? (If so, describe)
Has the dog ever bitten another dog when guarding a resource?
What have you done to correct the behavior?

Separation Anxiety
Where is dog left alone during the day when family isn’t home?
How long is dog left alone per day?
Is your dog comfortable being left alone?
If not, what behaviors does he exhibit when left alone? (barking, destructive chewing, digging, inappropriate elimination, other)
What have you done to correct the problem?
What person does the dog miss the most when they are gone?
Does the dog constantly follow you around the house?
What happens if you isolate the dog in the yard or in a room if you are home?

General
Describe your dog’s most undesirable behaviors.
What is your goal for training or modifying your dog’s unwanted behavior(s)?
What is your work schedule and availability for training?
Are you comfortable using food or other positive reinforcement methods to successfully modify behavior? (If not, please explain why)
Note: Emily has successfully modified thousands of dogs over 30 years of training experience. She uses positive methods to get long term behavior change.
Any additional information you would like to share regarding your dog’s behavior or temperament or history that may be relevant for assessment and training?

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