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Additional Owners
Would you like to add another owner?
*
Yes
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Your Information
Email
*
First Name
*
Last Name
*
Address
*
Street Address
City
WA
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Work Phone
Cell Phone
How did you hear about us?
Friend
Family
Ad
Vet
Yelp
Internet
Other
Emergency Contact
Name
*
Preferred Phone
*
Additional Phone
Your Pets
How many large dogs (>= 35lbs) would you like to enroll?
*
*if you have more than two large dogs, please complete this form for the first two and complete another form for the rest.
How many small dogs (<= 35lbs) would you like to enroll?
*
*if you have more than two small dogs, please complete this form for the first two and complete another form for the rest.
Please tell us about your pet (Large Dog #1)
Name
*
Breed
*
Color
*
Gender
*
Male
Female
Date of Birth
MM slash DD slash YYYY
Age
Is your dog displaying aggressive behaviors?
*
Yes
No
Is your dog displaying anxious behaviors?
*
Yes
No
Is your dog spayed or neutered?
*
Yes
No
DOG IDENTIFICATION
ID Tag
Tattoo
Microchip
Veterinarian
Vet Phone
Medical Conditions
Medication and Dosage
FEEDING
What kind of food does your dog eat?
*
How often do you feed your dog?
*
Does your dog have any food allergies? If yes, please explain.
*
BEHAVIOR
List any problems your pet has with people, pets or situations.
Has your pet ever snapped at anyone?
Yes
No
Will your pet share toys with other animals?
Yes
No
Has your pet ever jumped a fence or barrier?
Yes
No
List any restrictions that should be placed on your pet's activities
Does your pet mark or spray inside the house?
Yes
No
Anything else you would like to share?
Aggression and Anxiety Questions
What is the main behavior problem or complaint?
Additional Problems?
How frequently does the problem occur?
CHRONOLOGY
When did you first notice the main problem?
When did it first become a serious concern?
In what general circumstances does the dog misbehave?
Please describe if and how the problem has changed in frequency:
Please describe if and how the problem has changed in intensity:
Please describe if and how the problem has changed otherwise:
Describe several examples in detail (including date):
What have you done so far to try to correct the problem?
How do you discipline your dog for this and for other misbehavior?
HOME ENVIRONMENT
Please list the name and age of all people, including yourself, living in your household
Please list the name, species, breed, sex, age and age obtained for all animals living in your household
In what sequence were the above animals obtained?
Please describe your dog's relationship to the other animals:
What type of area do you live in?
City/Town
Suburbs
Rural
Please describe your home (house/apartment, yard, square footage, etc.):
Have you moved since acquiring your dog?
Yes
No
How many times?
Has your household (people or animals) changed since acquiring your dog?
Yes
No
If yes, please describe:
BACKGROUND
Why did you decide to get a dog?
Why did you choose this breed?
Where did you get this dog?
Have you owned dogs before?
Yes
No
If known, how many female littermates?
If known, how many male littermates?
How many animals were there to choose from?
Why did you choose this dog over the others? (Please be specific)
Was a temperament test performed?
Yes
No
Unsure
Result:
Describe your dog's behavior as a puppy:
Please describe any news about littermate behavior:
Did you meet the parents?
*
Yes
No
If yes, please describe their behavior:
Has this dog had other owners?
*
Yes
No
If yes, how many?
Why was the dog given up?
At what age was your dog neutered/spayed?
If known, why was the dog neutered/spayed at this age?
Were there any behavior changes after neutering/spay?
Has your dog ever been bred?
Yes
No
Unsure
Are you planning to breed?
Yes
No
Unsure
If your dog is female and intact, when was her last heat? Was it normal?
DIET AND FEEDING
What do you feed your dog? Please be specific (brand name, etc.):
Please describe any changes to your dog's appetite:
How many meals do you feed your dog and at what times?
Who feeds the dog and where?
What is your dog's favorite treat?
DAILY SCHEDULE
Please describe in detail a typical 24-hour day in your dog's life:
How does the dog behave with familiar visitors?
How does the dog behave with unfamiliar visitors (children or adults)?
How do you exercise your dog?
Is the dog free in a fenced yard?
Yes
No
Is the dog tied outside?
Yes
No
Does the dog run free?
Yes
No
How do you play with your dog?
What toys does the dog have?
Is your dog housetrained?
Yes
No
How was the dog housetrained?
Does your dog ever urinate in the house?
Yes
No
Does your dog ever defecate in the house?
Yes
No
Where does your dog sleep at night?
Where is your dog when alone in the house?
Where is your dog when you have guests?
How does your dog behave while you are leaving the house?
How does your dog behave when you return?
OBEDIENCE TRAINING
What basic obedience training has your dog had?
None
Trained at home
Started obedience classes but didn't finish
Graduated obedience class once
Graduated obedience class two or more levels
Private trainer
Other
How old was the dog when obedience training started?
Who in the family is the primary trainer?
What, if any, awards or titles has your dog won?
Has your dog had any hunting, herding, protection, attack, or Schutzhund training? If so when, and with whom?
What percent of the time does your dog obey the following commands for each member of the family? Please indicate each family member's name and % for each command.
Family member #1
Sit
Down
Stay
Come
Heel
Family member #2
Sit
Down
Stay
Come
Heel
Family member #3
Sit
Down
Come
Stay
Heel
If you have more family members use the space below to indicate the percentage for each here:
OTHER BEHAVIOR
Please describe what tricks your dog knows, if any:
Does your dog jump up on you or others without permission?
Yes
No
Does your dog paw at you or at others?
Yes
No
Does your dog lick you?
Yes
No
Does your dog mount people?
Yes
No
If yes, whom does your dog mount?
Does your dog mount animals or objects?
Yes
No
If yes, please describe:
Does your dog ever bark at you?
Yes
No
If yes, when?
Does your dog bark at other times?
What is your dog's activity level in general?
MEDICAL HISTORY
Is your dog on any medication now, for this or other problems?
Has your dog been on medication in the past?
Yes
No
Date of most recent rabies vaccination:
Type of rabies shot:
1 Year
3 Year
AGGRESSION SCREEN ACTIONS
Please select any and all the actions your dog takes when each of these behaviors is performed
Pet Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Hug Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Kiss Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Lift Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Call Off Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Push/Pull Off Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach on Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Disturb While Resting/Sleeping
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach While Eating
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Dog Food Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Human Food Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Water Dish Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Rawhide
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Biscuit/Cookie
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Real Bone
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Toy/Object
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach When Dog Has Any Object/Toy/Bone
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Verbally Punish
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Physically Punish
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Visual Threat
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Speak to Dog (Normal Tone)
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Stare at Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Bend Over Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Push on Shoulders or Back
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach Dog Near Spouse
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Enter Room
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leave Room
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Reach Toward Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leash Restraint
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Scruff Restraint
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Put Leash On/Take Off
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Put Collar On
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Collar Off
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Bathe Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Towel Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Groom/Brush Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog at Groomer's
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Trim Nails
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leash/Collar Correction
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog at Vet Clinic
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Adult Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Child Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Familiar Adult Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Familiar Child Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Toddlers/Babies
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog in Car at Tollbooths/Gas Stations
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Adult Approaches Owner, Dog on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Child Approaches Owner, Dog on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog in House, Sees People Outside
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Other Dogs While on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Other Dogs While Not on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Has your dog shown aggression towards people?
Yes
No
Aggression Towards People
Are attacks sudden and surprising?
Yes
No
Do the episodes appear unprovoked?
Yes
No
Is your dog abruptly docile afterwards?
Yes
No
Does the dog appear "sorry" afterwards?
Yes
No
Does the dog appear disoriented afterwards?
Yes
No
Are the episodes associated with a glazed or absent expression?
Yes
No
Can you usually tell what will set your dog off?
Yes
No
Is the aggressive behavior new and uncharacteristic?
Yes
No
Has your dog bitten and broken skin?
Yes
No
How many bites have broken skin?
How many bites total?
Total number of episodes of aggression:
Describe typical episode, including circumstances and dog's response:
How reliably do the above circumstances cause that response in your dog?
What parts of the body has the dog bitten and how severe were the injuries?
Who are typically the targets of aggression?
Did your dog bite as a puppy?
Yes
No
If yes, please describe, including age:
At what age did your dog first growl at a person?
What was the circumstance?
At what age did your dog first snap or bite at a person?
What was the circumstance?
Please tell us about your pet (Large Dog #2)
Name
*
Breed
*
Color
*
Gender
*
Male
Female
Date of Birth
MM slash DD slash YYYY
Age
Is your dog displaying aggressive behaviors?
*
Yes
No
Is your dog displaying anxious behaviors?
*
Yes
No
Is your dog spayed or neutered?
*
Yes
No
DOG IDENTIFICATION
ID Tag
Tattoo
Microchip
Veterinarian
Vet Phone
Medical Conditions
Medication and Dosage
FEEDING
What kind of food does your dog eat?
*
How often do you feed your dog?
*
Does your dog have any food allergies? If yes, please explain.
*
BEHAVIOR
List any problems your pet has with people, pets or situations.
Has your pet ever snapped at anyone?
Yes
No
Will your pet share toys with other animals?
Yes
No
Has your pet ever jumped a fence or barrier?
Yes
No
List any restrictions that should be placed on your pet's activities
Does your pet mark or spray inside the house?
Yes
No
Anything else you would like to share?
Aggression and Anxiety Questions
What is the main behavior problem or complaint?
Additional Problems?
How frequently does the problem occur?
CHRONOLOGY
When did you first notice the main problem?
When did it first become a serious concern?
In what general circumstances does the dog misbehave?
Please describe if and how the problem has changed in frequency:
Please describe if and how the problem has changed in intensity:
Please describe if and how the problem has changed otherwise:
Describe several examples in detail (including date):
What have you done so far to try to correct the problem?
How do you discipline your dog for this and for other misbehavior?
HOME ENVIRONMENT
Please list the name and age of all people, including yourself, living in your household
Please list the name, species, breed, sex, age and age obtained for all animals living in your household
In what sequence were the above animals obtained?
Please describe your dog's relationship to the other animals:
What type of area do you live in?
City/Town
Suburbs
Rural
Please describe your home (house/apartment, yard, square footage, etc.):
Have you moved since acquiring your dog?
Yes
No
How many times?
Has your household (people or animals) changed since acquiring your dog?
Yes
No
If yes, please describe:
BACKGROUND
Why did you decide to get a dog?
Why did you choose this breed?
Where did you get this dog?
Have you owned dogs before?
Yes
No
If known, how many female littermates?
If known, how many male littermates?
How many animals were there to choose from?
Why did you choose this dog over the others? (Please be specific)
Was a temperament test performed?
Yes
No
Unsure
Result:
Describe your dog's behavior as a puppy:
Please describe any news about littermate behavior:
Did you meet the parents?
*
Yes
No
If yes, please describe their behavior:
Has this dog had other owners?
*
Yes
No
If yes, how many?
Why was the dog given up?
At what age was your dog neutered/spayed?
If known, why was the dog neutered/spayed at this age?
Were there any behavior changes after neutering/spay?
Has your dog ever been bred?
Yes
No
Unsure
Are you planning to breed?
Yes
No
Unsure
If your dog is female and intact, when was her last heat? Was it normal?
DIET AND FEEDING
What do you feed your dog? Please be specific (brand name, etc.):
Please describe any changes to your dog's appetite:
How many meals do you feed your dog and at what times?
Who feeds the dog and where?
What is your dog's favorite treat?
DAILY SCHEDULE
Please describe in detail a typical 24-hour day in your dog's life:
How does the dog behave with familiar visitors?
How does the dog behave with unfamiliar visitors (children or adults)?
How do you exercise your dog?
Is the dog free in a fenced yard?
Yes
No
Is the dog tied outside?
Yes
No
Does the dog run free?
Yes
No
How do you play with your dog?
What toys does the dog have?
Is your dog housetrained?
Yes
No
How was the dog housetrained?
Does your dog ever urinate in the house?
Yes
No
Does your dog ever defecate in the house?
Yes
No
Where does your dog sleep at night?
Where is your dog when alone in the house?
Where is your dog when you have guests?
How does your dog behave while you are leaving the house?
How does your dog behave when you return?
OBEDIENCE TRAINING
What basic obedience training has your dog had?
None
Trained at home
Started obedience classes but didn't finish
Graduated obedience class once
Graduated obedience class two or more levels
Private trainer
Other
How old was the dog when obedience training started?
Who in the family is the primary trainer?
What, if any, awards or titles has your dog won?
Has your dog had any hunting, herding, protection, attack, or Schutzhund training? If so when, and with whom?
What percent of the time does your dog obey the following commands for each member of the family? Please indicate each family member's name and % for each command.
Family member #1
Sit
Stay
Come
Down
Heel
Family member #2
Sit
Down
Stay
Come
Heel
Family member #3
Sit
Down
Stay
Come
Heel
If you have more family members use the space below to indicate the percentage for each here:
OTHER BEHAVIOR
Please describe what tricks your dog knows, if any:
Does your dog jump up on you or others without permission?
Yes
No
Does your dog paw at you or at others?
Yes
No
Does your dog lick you?
Yes
No
Does your dog mount people?
Yes
No
If yes, whom does your dog mount?
Does your dog mount animals or objects?
Yes
No
If yes, please describe:
Does your dog ever bark at you?
Yes
No
If yes, when?
Does your dog bark at other times?
What is your dog's activity level in general?
MEDICAL HISTORY
Is your dog on any medication now, for this or other problems?
Has your dog been on medication in the past?
Yes
No
Date of most recent rabies vaccination:
Type of rabies shot:
1 Year
3 Year
AGGRESSION SCREEN ACTIONS
Please select any and all the actions your dog takes when each of these behaviors is performed
Pet Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Hug Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Kiss Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Lift Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Call Off Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Push/Pull Off Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach on Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Disturb While Resting/Sleeping
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach While Eating
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Dog Food Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Human Food Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Water Dish Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Rawhide
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Biscuit/Cookie
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Real Bone
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Toy/Object
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach When Dog Has Any Object/Toy/Bone
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Verbally Punish
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Physically Punish
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Visual Threat
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Speak to Dog (Normal Tone)
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Stare at Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Bend Over Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Push on Shoulders or Back
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach Dog Near Spouse
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Enter Room
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leave Room
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Reach Toward Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leash Restraint
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Scruff Restraint
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Put Leash On/Take Off
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Put Collar On
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Collar Off
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Bathe Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Towel Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Groom/Brush Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog at Groomer's
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Trim Nails
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leash/Collar Correction
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog at Vet Clinic
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Adult Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Child Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Familiar Adult Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Familiar Child Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Toddlers/Babies
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog in Car at Tollbooths/Gas Stations
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Adult Approaches Owner, Dog on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Child Approaches Owner, Dog on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog in House, Sees People Outside
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Other Dogs While on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Other Dogs While Not on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Has your dog shown aggression towards people?
Yes
No
Aggression Towards People
Are attacks sudden and surprising?
Yes
No
Do the episodes appear unprovoked?
Yes
No
Is your dog abruptly docile afterwards?
Yes
No
Does the dog appear sorry afterwards?
Yes
No
Does the dog appear disoriented afterwards?
Yes
No
Are the episodes associated with a glazed or absent expression?
Yes
No
Can you usually tell what will set your dog off?
Yes
No
Is the aggressive behavior new and uncharacteristic?
Yes
No
Has your dog bitten and broken skin?
Yes
No
How many bites have broken skin?
How many bites total?
Total number of episodes of aggression:
Describe typical episode, including circumstances and dog's response:
How reliably do the above circumstances cause that response in your dog?
What parts of the body has the dog bitten and how severe were the injuries?
Who are typically the targets of aggression?
Did your dog bite as a puppy?
Yes
No
If yes, please describe, including age:
At what age did your dog first growl at a person?
What was the circumstance?
At what age did your dog first snap or bite at a person?
What was the circumstance?
Please tell us about your pet (Small Dog #1)
Name
*
Breed
*
Color
*
Gender
*
Male
Female
Date of Birth
MM slash DD slash YYYY
Age
Is your dog displaying aggressive behaviors?
*
Yes
No
Is your dog displaying anxious behaviors?
*
Yes
No
Is your dog spayed or neutered?
*
Yes
No
DOG IDENTIFICATION
ID Tag
Tattoo
Microchip
Medical Conditions
Medication and Dosage
FEEDING
What kind of food does your dog eat?
*
How often do you feed your dog?
*
Does your dog have any food allergies? If yes, please explain.
*
BEHAVIOR
List any problems your pet has with people, pets or situations.
Has your pet ever snapped at anyone?
Yes
No
Has your pet ever bitten another animal?
Yes
No
Will your pet share toys with other animals?
Yes
No
Has your pet ever jumped a fence or barrier?
Yes
No
List any restrictions that should be placed on your pet's activities
Does your pet mark or spray inside the house?
Yes
No
Anything else you would like to share?
Aggression and Anxiety Questions
What is the main behavior problem or complaint?
Additional Problems?
How frequently does the problem occur?
CHRONOLOGY
When did you first notice the main problem?
When did it first become a serious concern?
In what general circumstances does the dog misbehave?
Please describe if and how the problem has changed in frequency:
Please describe if and how the problem has changed in intensity:
Please describe if and how the problem has changed otherwise:
Describe several examples in detail (including date):
What have you done so far to try to correct the problem?
How do you discipline your dog for this and for other misbehavior?
HOME ENVIRONMENT
Please list the name and age of all people, including yourself, living in your household
Please list the name, species, breed, sex, age and age obtained for all animals living in your household
In what sequence were the above animals obtained?
Please describe your dog's relationship to the other animals:
What type of area do you live in?
City/Town
Suburbs
Rural
Please describe your home (house/apartment, yard, square footage, etc.):
Have you moved since acquiring your dog?
Yes
No
How many times?
Has your household (people or animals) changed since acquiring your dog?
Yes
No
If yes, please describe:
BACKGROUND
Why did you decide to get a dog?
Why did you choose this breed?
Where did you get this dog?
Have you owned dogs before?
Yes
No
If known, how many female littermates?
If known, how many male littermates?
How many animals were there to choose from?
Why did you choose this dog over the others? (Please be specific)
Was a temperament test performed?
Yes
No
Unsure
Result:
Describe your dog's behavior as a puppy:
Please describe any news about littermate behavior:
Did you meet the parents?
*
Yes
No
If yes, please describe their behavior:
Has this dog had other owners?
*
Yes
No
If yes, how many?
Why was the dog given up?
At what age was your dog neutered/spayed?
If known, why was the dog neutered/spayed at this age?
Were there any behavior changes after neutering/spay?
Has your dog ever been bred?
Yes
No
Unsure
Are you planning to breed?
Yes
No
Unsure
If your dog is female and intact, when was her last heat? Was it normal?
DIET AND FEEDING
What do you feed your dog? Please be specific (brand name, etc.):
Please describe any changes to your dog's appetite:
How many meals do you feed your dog and at what times?
Who feeds the dog and where?
What is your dog's favorite treat?
DAILY SCHEDULE
Please describe in detail a typical 24-hour day in your dog's life:
How does the dog behave with familiar visitors?
How does the dog behave with unfamiliar visitors (children or adults)?
How do you exercise your dog?
Is the dog free in a fenced yard?
Yes
No
Is the dog tied outside?
Yes
No
Does the dog run free?
Yes
No
How do you play with your dog?
What toys does the dog have?
Is your dog housetrained?
Yes
No
How was the dog housetrained?
Does your dog ever urinate in the house?
Yes
No
Does your dog ever defecate in the house?
Yes
No
Where does your dog sleep at night?
Where is your dog when alone in the house?
Where is your dog when you have guests?
How does your dog behave while you are leaving the house?
How does your dog behave when you return?
OBEDIENCE TRAINING
What basic obedience training has your dog had?
None
Trained at home
Started obedience classes but didn't finish
Graduated obedience class once
Graduated obedience class two or more levels
Private trainer
Other
How old was the dog when obedience training started?
Who in the family is the primary trainer?
What, if any, awards or titles has your dog won?
Has your dog had any hunting, herding, protection, attack, or Schutzhund training? If so when, and with whom?
What percent of the time does your dog obey the following commands for each member of the family? Please indicate each family member's name and % for each command.
Family member #1
Sit
Stay
Come
Down
Heel
Family member #2
Sit
Stay
Come
Down
Heel
Family member #3
Sit
Down
Stay
Come
Heel
If you have more family members use the space below to indicate the percentage for each here:
OTHER BEHAVIOR
Please describe what tricks your dog knows, if any:
Does your dog jump up on you or others without permission?
Yes
No
Does your dog paw at you or at others?
Yes
No
Does your dog lick you?
Yes
No
Does your dog mount people?
Yes
No
If yes, whom does your dog mount?
Does your dog mount animals or objects?
Yes
No
If yes, please describe:
Does your dog ever bark at you?
Yes
No
If yes, when?
Does your dog bark at other times?
What is your dog's activity level in general?
MEDICAL HISTORY
Is your dog on any medication now, for this or other problems?
Has your dog been on medication in the past?
Yes
No
Date of most recent rabies vaccination:
Type of rabies shot:
1 Year
3 Year
Hourly Rate
7 Private Lessons
14 Private Lessons
28 Private Lessons
Pet Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Hug Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Kiss Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Lift Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Call Off Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Push/Pull Off Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach on Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Disturb While Resting/Sleeping
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach While Eating
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Dog Food Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Human Food Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Water Dish Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Rawhide
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Biscuit/Cookie
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Real Bone
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Toy/Object
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach When Dog Has Any Object/Toy/Bone
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Verbally Punish
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Physically Punish
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Visual Threat
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Speak to Dog (Normal Tone)
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Stare at Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Bend Over Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Push on Shoulders or Back
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach Dog Near Spouse
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Enter Room
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leave Room
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Reach Toward Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leash Restraint
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Scruff Restraint
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Put Leash On/Take Off
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Put Collar On
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Collar Off
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Bathe Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Towel Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Groom/Brush Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog at Groomer's
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Trim Nails
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leash/Collar Correction
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog at Vet Clinic
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Adult Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Child Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Familiar Adult Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Familiar Child Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Toddlers/Babies
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog in Car at Tollbooths/Gas Stations
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Adult Approaches Owner, Dog on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Child Approaches Owner, Dog on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog in House, Sees People Outside
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Other Dogs While on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Other Dogs While Not on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
AGGRESSION SCREEN ACTIONS
Please select any and all the actions your dog takes when each of these behaviors is performed
Has your dog shown aggression towards people?
Yes
No
Aggression Towards People
Are attacks sudden and surprising?
Yes
No
Do the episodes appear unprovoked?
Yes
No
Is your dog abruptly docile afterwards?
Yes
No
Does the dog appear sorry afterwards?
Yes
No
Does the dog appear disoriented afterwards?
Yes
No
Are the episodes associated with a glazed or absent expression?
Yes
No
Can you usually tell what will set your dog off?
Yes
No
Is the aggressive behavior new and uncharacteristic?
Yes
No
Has your dog bitten and broken skin?
Yes
No
How many bites have broken skin?
How many bites total?
Total number of episodes of aggression:
Describe typical episode, including circumstances and dog's response:
How reliably do the above circumstances cause that response in your dog?
What parts of the body has the dog bitten and how severe were the injuries?
Who are typically the targets of aggression?
Did your dog bite as a puppy?
Yes
No
If yes, please describe, including age:
At what age did your dog first growl at a person?
What was the circumstance?
At what age did your dog first snap or bite at a person?
What was the circumstance?
Please tell us about your pet (Small Dog #2)
Name
*
Breed
*
Color
*
Gender
*
Male
Female
Date of Birth
MM slash DD slash YYYY
Age
Is your dog displaying aggressive behaviors?
*
Yes
No
Is your dog displaying anxious behaviors?
*
Yes
No
Is your dog spayed or neutered?
*
Yes
No
DOG IDENTIFICATION
ID Tag
Tattoo
Microchip
Veterinarian
Vet Phone
Medical Conditions
Medication and Dosage
FEEDING
What kind of food does your dog eat?
*
How often do you feed your dog?
*
Does your dog have any food allergies? If yes, please explain.
*
BEHAVIOR
List any problems your pet has with people, pets or situations.
Has your pet ever snapped at anyone?
Yes
No
Has your pet ever bitten another animal?
Yes
No
Will your pet share toys with other animals?
Yes
No
Has your pet ever jumped a fence or barrier?
Yes
No
List any restrictions that should be placed on your pet's activities
Does your pet mark or spray inside the house?
Yes
No
Anything else you would like to share?
Aggression and Anxiety Questions
What is the main behavior problem or complaint?
Additional Problems?
How frequently does the problem occur?
CHRONOLOGY
When did you first notice the main problem?
When did it first become a serious concern?
In what general circumstances does the dog misbehave?
Please describe if and how the problem has changed in frequency:
Please describe if and how the problem has changed in intensity:
Please describe if and how the problem has changed otherwise:
Describe several examples in detail (including date):
What have you done so far to try to correct the problem?
How do you discipline your dog for this and for other misbehavior?
HOME ENVIRONMENT
Please list the name and age of all people, including yourself, living in your household
Please list the name, species, breed, sex, age and age obtained for all animals living in your household
In what sequence were the above animals obtained?
Please describe your dog's relationship to the other animals:
What type of area do you live in?
City/Town
Suburbs
Rural
Please describe your home (house/apartment, yard, square footage, etc.):
Have you moved since acquiring your dog?
Yes
No
How many times?
Has your household (people or animals) changed since acquiring your dog?
Yes
No
If yes, please describe:
BACKGROUND
Why did you decide to get a dog?
Why did you choose this breed?
Where did you get this dog?
Have you owned dogs before?
Yes
No
If known, how many female littermates?
If known, how many male littermates?
How many animals were there to choose from?
Why did you choose this dog over the others? (Please be specific)
Was a temperament test performed?
Yes
No
Unsure
Result:
Describe your dog's behavior as a puppy:
Please describe any news about littermate behavior:
Did you meet the parents?
*
Yes
No
If yes, please describe their behavior:
Has this dog had other owners?
*
Yes
No
If yes, how many?
Why was the dog given up?
At what age was your dog neutered/spayed?
If known, why was the dog neutered/spayed at this age?
Were there any behavior changes after neutering/spay?
Has your dog ever been bred?
Yes
No
Unsure
Are you planning to breed?
Yes
No
Unsure
If your dog is female and intact, when was her last heat? Was it normal?
DIET AND FEEDING
What do you feed your dog? Please be specific (brand name, etc.):
Please describe any changes to your dog's appetite:
How many meals do you feed your dog and at what times?
Who feeds the dog and where?
What is your dog's favorite treat?
DAILY SCHEDULE
Please describe in detail a typical 24-hour day in your dog's life:
How does the dog behave with familiar visitors?
How does the dog behave with unfamiliar visitors (children or adults)?
How do you exercise your dog?
Is the dog free in a fenced yard?
Yes
No
Is the dog tied outside?
Yes
No
Does the dog run free?
Yes
No
How do you play with your dog?
What toys does the dog have?
Is your dog housetrained?
Yes
No
How was the dog housetrained?
Does your dog ever urinate in the house?
Yes
No
Does your dog ever defecate in the house?
Yes
No
Where does your dog sleep at night?
Where is your dog when alone in the house?
Where is your dog when you have guests?
How does your dog behave while you are leaving the house?
How does your dog behave when you return?
OBEDIENCE TRAINING
What basic obedience training has your dog had?
None
Trained at home
Started obedience classes but didn't finish
Graduated obedience class once
Graduated obedience class two or more levels
Private trainer
Other
How old was the dog when obedience training started?
Who in the family is the primary trainer?
What, if any, awards or titles has your dog won?
Has your dog had any hunting, herding, protection, attack, or Schutzhund training? If so when, and with whom?
What percent of the time does your dog obey the following commands for each member of the family? Please indicate each family member's name and % for each command.
Family member #1
Sit
Stay
Come
Down
Heel
Family member #2
Sit
Stay
Come
Down
Heel
Family member #3
Sit
Stay
Come
Down
Heel
If you have more family members use the space below to indicate the percentage for each here:
OTHER BEHAVIOR
Please describe what tricks your dog knows, if any:
Does your dog jump up on you or others without permission?
Yes
No
Does your dog paw at you or at others?
Yes
No
Does your dog lick you?
Yes
No
Does your dog mount people?
Yes
No
If yes, whom does your dog mount?
Does your dog mount animals or objects?
Yes
No
If yes, please describe:
Does your dog ever bark at you?
Yes
No
If yes, when?
Does your dog bark at other times?
What is your dog's activity level in general?
MEDICAL HISTORY
Is your dog on any medication now, for this or other problems?
Has your dog been on medication in the past?
Yes
No
Date of most recent rabies vaccination:
Type of rabies shot:
1 Year
3 Year
AGGRESSION SCREEN ACTIONS
Please select any and all the actions your dog takes when each of these behaviors is performed
Pet Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Hug Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Kiss Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Lift Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Call Off Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Push/Pull Off Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach on Furniture
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Disturb While Resting/Sleeping
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach While Eating
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Dog Food Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Human Food Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Water Dish Away
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Rawhide
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Biscuit/Cookie
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Real Bone
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Toy/Object
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach When Dog Has Any Object/Toy/Bone
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Verbally Punish
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Physically Punish
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Visual Threat
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Speak to Dog (Normal Tone)
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Stare at Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Bend Over Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Push on Shoulders or Back
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Approach Dog Near Spouse
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Enter Room
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leave Room
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Reach Toward Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leash Restraint
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Scruff Restraint
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Put Leash On/Take Off
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Put Collar On
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Take Collar Off
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Bathe Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Towel Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Groom/Brush Dog
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog at Groomer's
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Trim Nails
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Leash/Collar Correction
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to "Sit"
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to "Down"
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog at Vet Clinic
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Adult Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Child Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Familiar Adult Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Familiar Child Enters House or Yard
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Toddlers/Babies
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog in Car at Tollbooths/Gas Stations
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Adult Approaches Owner, Dog on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Unfamiliar Child Approaches Owner, Dog on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Dog in House, Sees People Outside
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Other Dogs While on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Response to Other Dogs While Not on Leash
Growl
Snarl / Bare Teeth
Snap / Bite
No Reaction
N/A
Has your dog shown aggression towards people?
Yes
No
Aggression Towards People
Are attacks sudden and surprising?
Yes
No
Do the episodes appear unprovoked?
Yes
No
Is your dog abruptly docile afterwards?
Yes
No
Does the dog appear sorry afterwards?
Yes
No
Does the dog appear disoriented afterwards?
Yes
No
Are the episodes associated with a glazed or absent expression?
Yes
No
Can you usually tell what will set your dog off?
Yes
No
Is the aggressive behavior new and uncharacteristic?
Yes
No
Has your dog bitten and broken skin?
Yes
No
How many bites have broken skin?
How many bites total?
Total number of episodes of aggression:
Describe typical episode, including circumstances and dog's response:
How reliably do the above circumstances cause that response in your dog?
What parts of the body has the dog bitten and how severe were the injuries?
Who are typically the targets of aggression?
Did your dog bite as a puppy?
Yes
No
If yes, please describe, including age:
At what age did your dog first growl at a person?
What was the circumstance?
At what age did your dog first snap or bite at a person?
What was the circumstance?
Services for Large Dog #1
TRAINING
Dog Training
Price:
Standard Pre-Training Evaluation Fee
Hourly Training Fee (Standard Large Dog)
Nitro Dog Hands On - Level 1
Price:
Three 1-Hour Lessons
Seven 1-Hour Lessons
Fourteen 1-Hour Lessons
Nitro Dog Hands On - Level 2
Price:
Three 1-Hour Lessons
Seven 1-Hour Lessons
Fourteen 1-Hour Lessons
Nitro Dog Hands Off - Level 1
Price:
Home Visits
Price:
1 Visit
3 Visits
7 Visits
14 Visits
BOARDING
Boarding Per Night (2 dog maximum)
Price:
1 Night
2 Nights
3 Nights
4 Nights
5 Nights
6 Nights
7 Nights
More than 7 Nights
BOARD AND TRAIN
Board and Train
Price:
1 Week Board and Train Program
2 Week Board and Train Program
3 Week Board and Train Program
4 Week Board and Train Program
5 Week Board and Train Program
6 Week Board and Train Program - Premium Package **
PET SITTING
Pet Sitting (Indicate # of Nights)
Quantity
Price:
$110.00
Quantity
DOG WALKING
Dog Walking
Price:
20 minutes
30 minutes
45 minutes
60 minutes
PERSONAL PROTECTION (RING OF FIRE)
Personal Protection (Ring of Fire)
Price:
Hourly Rate
7 Private Lessons
14 Private Lessons
28 Private Lessons
Services for Large Dog #2
TRAINING
Dog Training
Price:
Standard Pre-Training Evaluation Fee
Hourly Training Fee (Standard Large Dog)
Nitro Dog Hands On - Level 1
Price:
Three 1-Hour Lessons
Seven 1-Hour Lessons
Fourteen 1-Hour Lessons
Nitro Dog Hands On - Level 2
Price:
Three 1-Hour Lessons
Seven 1-Hour Lessons
Fourteen 1-Hour Lessons
Nitro Dog Hands Off - Level 1
Price:
1-Hour Lesson
Package: Fourteen 1-Hour Lessons
Home Visits
Price:
1 Visit
3 Visits
7 Visits
14 Visits
BOARDING
Boarding Per Night (2 dog maximum)
Price:
1 Night
2 Nights
3 Nights
4 Nights
5 Nights
6 Nights
7 Nights
More than 7 Nights
BOARD AND TRAIN
Board and Train
Price:
1 Week Board and Train Program
2 Week Board and Train Program
3 Week Board and Train Program
4 Week Board and Train Program
5 Week Board and Train Program
6 Week Board and Train Program Premium Package **
PET SITTING
Pet Sitting (Indicate # of Nights)
Quantity
Price:
$110.00
Quantity
DOG WALKING
Dog Walking
Price:
20 minutes
30 minutes
45 minutes
60 minutes
PERSONAL PROTECTION (RING OF FIRE)
Personal Protection (Ring of Fire)
Price:
Hourly Rate
7 Private Lessons
14 Private Lessons
28 Private Lessons
Services for Small Dog #1
TRAINING
Dog Training
Price:
Standard Pre-Training Evaluation Fee
Hourly Training Fee (Standard Small Dog)
Mini Heroes Hands On - Level 1
Price:
Three 30-Minute Lessons
Seven 30-Minute Lessons
Fourteen 30-Minute Lessons
Mini Heroes Hands On - Level 2
Price:
Three 30-Minute Lessons
Seven 30-Minute Lessons
Fourteen 30-Minute Lessons
Mini Heroes Hands Off - Level 1
Price:
1-Hour Lesson
Package: Fourteen 1-Hour Lessons
Home Visits
Price:
1 Visit
3 Visits
7 Visits
14 Visits
BOARDING
Boarding Per Night (2 dog maximum)
Price:
1 Night
2 Nights
3 Nights
4 Nights
5 Nights
6 Nights
7 Nights
More than 7 Nights
BOARD AND TRAIN
Board and Train
Price:
1 Week Board and Train Program
2 Week Board and Train Program
3 Week Board and Train Program
4 Week Board and Train Program
5 Week Board and Train Program
6 Week Board and Train Program - Premium Package **
PET SITTING
Pet Sitting (Indicate # of Nights)
Quantity
Price:
$110.00
Quantity
DOG WALKING
Dog Walking
Price:
20 minutes
30 minutes
45 minutes
60 minutes
PERSONAL PROTECTION (RING OF FIRE)
Personal Protection (Ring of Fire)
Price:
Hourly Rate
7 Private Lessons
14 Private Lessons
28 Private Lessons
Services for Small Dog #2
TRAINING
Dog Training
Price:
Standard Pre-Training Evaluation Fee
Hourly Training Fee (Standard Small Dog)
Mini Heroes Hands On - Level 1
Price:
Three 30-Minute Lessons
Seven 30-Minute Lessons
Fourteen 30-Minute Lessons
Mini Heroes Hands On - Level 2
Price:
Three 30-Minute Lessons
Seven 30-Minute Lessons
Fourteen 30-Minute Lessons
Mini Heroes Hands Off - Level 1
Price:
1-Hour Lesson
Package: Fourteen 1-Hour Lessons
Home Visits
Price:
1 Visit
3 Visits
7 Visits
14 Visits
BOARDING
Boarding Per Night (2 dog maximum)
Price:
1 Night
2 Nights
3 Nights
4 Nights
5 Nights
6 Nights
7 Nights
More than 7 Nights
BOARD AND TRAIN
Board and Train
Price:
1 Week Board and Train Program
2 Week Board and Train Program
3 Week Board and Train Program
4 Week Board and Train Program
5 Week Board and Train Program
6 Week Board and Train Program - Premium Package **
PET SITTING
Pet Sitting (Indicate # of Nights)
Quantity
Price:
$110.00
Quantity
DOG WALKING
Dog Walking
Price:
20 minutes
30 minutes
45 minutes
60 minutes
PERSONAL PROTECTION (RING OF FIRE)
Personal Protection (Ring of Fire)
Price:
Hourly Rate
7 Private Lessons
14 Private Lessons
28 Private Lessons
