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Download canine behavior questionnaire - The Paw Patch Place Indianapolis
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Dr. Jean’s Pet Behavior Service Jean DeLong, DVM 317-626-4737 [email protected] CANINE BEHAVIOR QUESTIONNAIRE 1- Name, age, breed and approximate weight of your pet? 2- Is your pet male or female? Spayed or neutered? If so, what age was your pet spayed or neutered? 3- Where did you adopt your dog from? ____Own breeding _____Pet shop ____Breeder _____Humane society ____Private home _____Stray _____Other (explain) 4- How old was your dog when you adopted it? 5- If obtained as a puppy, how was the puppy raised? _____In house _____Puppy mill _____In kennel/garage _____Don’t know _____Loose outside _____Other (explain) 6- If obtained as a puppy, how did you select that particular puppy from a litter? _____Breeder selected _____Most timid _____Looks _____No choice _____Biggest/dominant _____Other (explain) _____Most outgoing _____Smallest/submissive 7- Primary purpose for which this dog was obtained: _____Adult’s pet _____Watch/guard dog _____Family’s pet _____Farm/outside dog _____Children’s pet _____Obedience _____Show dog _____Breeding _____Service/working dog _____Hunting dog _____Other (explain) 8- Did your dog have any previous owners and what was its primary purpose for that owner? 9- Average number of hours your dog is left alone per weekday. Is your schedule consistent on weekdays or does it vary? 10- Where is the dog when left alone? _____Cage _____Confined in a room _____Loose in a living room _____Basement _____Garage _____Outside kennel _____Outside tied _____Loose in yard 11- Where is the dog at night? _____Cage _____Confined in a room _____Loose in a living room _____Basement _____Garage _____Bedroom _____Other (explain) _____On person’s bed _____Outside _____Other (explain) 12- What percentage of the day does your dog spend inside? What % outside? 13- Does your dog have any medical problems? Is your dog taking any medications? 14- What kind of living situation do you have? _____Apartment ____ House with small yard _____Townhouse/condo _____House with large yard 15- How many times is your dog walked? ____<1/week _____once/day ____several/week _____twice/day _____Farm _____Other (explain) _____3x/day _____>3x/day 15- What is the average length of time your dog gets walked? Is the exercise schedule consistent or does it vary during the week? 16- Dog is walked on: _____Off leash _____Harness _____Flat collar _____Halter _____Choke chain _____Pinch collar 17- How often do you play with toys or play games with the pet inside the house daily (on average)? How often outside the house? 18- How long does each play bout last (on average) in minutes? 19- How often is your dog fed meals each day? What brand of dog food do you feed? 20- How often is your dog fed treats each day? What kind of treats? 21- How often is your dog fed snacks from the table? 22- Please list all persons living in the house: #Adults(>18yrs):_____________________________________________________________________ #Children and ages __________________________________________________________________ 23- Who is the primary caretaker of the dog? 24- Please list all pets in the household. NAME BREED SEX AGE RANK Patient ___________________________________________________________________________ DOG 2 ___________________________________________________________________________ DOG 3 ____________________________________________________________________________ DOG 4 _________________________________________________________________________ OTHER PETS 25- Any changes in the household since you adopted your dog? Death of a human or pet, marriage/divorce, baby born, pet added, move? 26- What is your dog’s obedience school history? _____No training at all _____No school-trained yourself _____Puppy kindergarten _____Group lessons- basic _____Group lessons- advanced _____Private trainer at house _____Private trainer- sent to trainer 27- How old was the dog when lessons/training started? 28- Who took the dog to obedience school? 29- How did the dog do in obedience school? 30 - What commands does the dog know and how well? Sit Stay Lie down Come Wait Heel Fetch Drop it Almost perfect ____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________ Usually OK _____________ _____________ _____________ _____________ _____________ _____________ ______________ _____________ Needs work _____________ _____________ _____________ _____________ _____________ _____________ _____________ _____________ 31- Is your dog crate trained? 32- What type of collar do you use for training? 33- What type of disciplines have you used and describe: _____none ever ______startling _____response substitution ______physical _____verbal reprimand ______shock _____distracting ______time out _____shake down _____roll over 34- How would you generally describe your dog’s personality? _____Friendly to owner _____Aggressive to strangers _____Aloof _____Shy of strangers _____Aggressive to owner _____Happy, outgoing _____Aloof to strangers _____Inhibited _____Friendly to strangers _____Anxious Comments: 35- What was the personality of your dog as a puppy? _____Friendly to owner ______Aggressive to strangers _____Aloof ______Shy of strangers _____Aggressive to owner ______Happy, outgoing _____Aloof to strangers ______Inhibited _____Friendly to strangers ______Anxious Comments: _____Hyperexcitable _____Supersubmissive _____Fearful _____Fear of noises _____Hyperexcitable _____Supersubmissive _____Fearful _____Fear of noises 36- Describe how you prepare to leave the house when your dog will be left alone. Do you ignore your dog, seek it out to say goodbye, do you make a fuss, etc…? 37-What does your pet do as you prepare to leave? 38-What does your pet do when you get home? 39- Does your dog usually follow you around the house and try to maintain physical or visual contact? 40- Does your dog regularly (at least weekly) engage in the following: NO When owner present Only in owner’s absence Don’t know (times/week) (times/week) Excessive barking, whining _____ _________________ ____________________ ______ House soiling _____ _________________ ____________________ ______ Destructive chewing _____ _________________ ____________________ ______ Self licking/chewing _____ _________________ ____________________ ______ Digging _____ _________________ ___________________ _______ Excessive salivation _____ __________________ ____________________ _______ 41- Main behavioral concerns for behavioral consult (list in order of importance) 42- Reason for scheduling behavioral consult and goals you have for the behavioral consult. 43- Record a DETAILED description of events and how long ago each event occurred. What happened? Where did it happen? Who was present? What triggers the incident? How does the dog behave before and afterwards? (Describe in body language. Don’t just say he was being spiteful) How do people react? Use the back of the questionnaire or another sheet of paper if needed.
