Dog Assessment Questionnaire

When you fill in this questionnaire, please be as accurate and as honest as you can.

Do not feel that you are being disloyal to your dog or family - say it as it is.

The more information you give me, the more accurately I will understand your situation, and the more effectively I can help you.

If your dog has bitten - tell me.
If your dog guards their bed, or anything else - tell me.
If your dog barks so much when people visit you have stopped having friends over - tell me.

I am here to help, not to judge.

Owners Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Your Dog

Name

Breed

Age

Sex

Sex of your dog, specify if neutered at what age

Place and Age when Acquired

Where did you get the dog and how old was it

Problems

Please list every issue you consider the dog has

Other Pets

List any other pets in the home, including other dogs with breed, age, and sex, and if neutered

Food

What types and brands of food does your dog eat, include any treats or snacks, and any supplements and/or medication

Mealtimes

When and where does your dog eat, specify times and who normally feeds it, and if they eat before or after you

Food Guarding

Does your dog bark, growl, or become aggressive when eating food or snacks

Yes

Sleep & Rest

When and where does your dog sleep, what times, and where do they rest, especially when you are out, are they confined to an area, are they in a crate or pen

Exercise

How often is your dog exercised, for how long, where, and normally who does it, how long is the dog off-lead when out

Lead & Harness

Describe the lead and/or harness normally used to walk, include muzzle, etc

Toys & Games

What is your dog's favourite toys, where are they normally kept and how often do you play games using toys

Resource Guarding

Does your dog bark, growl, or become aggressive around toys, or any found objects, or do they guard their bed

Yes

Bathing & Grooming

Do you bathe or groom your dog, how often, and is it done professionally, how does your dog react to bathing or grooming

Social Contact

How does your dog react to other family, to visitors, to strangers, to other pets, and to other dogs, on and off lead

Biting

Has your dog ever growled at, or bitten anyone (including you) after age 5 months

Yes

Bite Details

If your dog has ever bitten someone then please give details

Destructive Behaviour

Does your dog cause damage within the home, e.g. furniture, carpets, skirting, etc, if so give details, state whether this occurs when you are home or not

Any Other Details

Please give any additional information