Please Complete Your Reactive Dog Intake Form

Reactivity Intake Form

Full Name *

Email *

Medical History

Initial medical history questionnaire can be found in the New Client Intake Form.

Has your dog ever had a litter of puppies?

At what age was your dog fixed:

Did your dog’s behavior change in anyway after being altered?

What changed?

List of current medications or supplements:

What brand and type of flea preventative?

What side effects does your dog’s medication have?

Overview

Describe the reason for your consultation today:

What do you want to accomplish with this consultation?

What about your dog’s behavior concerns you the most?

What do you wish to accomplish with training?

Behavioral History

Early Life

What kind of environment was your dog raised in before 8 weeks old?

Where did you get your dog from?

How much interaction has the dog had with dogs during the first year of their life?

If you got your dog as a puppy, what kinds of places did you take him to before he was 4 months old?

If you got your dog as a puppy, what was his reaction to dogs when he was under 4 months old?

What pet stores, doggy day cares, vet clinics, groomers, or other pet facilities did you take him to before the age of 6 months old?

How old was your dog when you began noticing your dog’s reactions towards other dogs?

Did your dog ever have a negative interaction with another dog as a puppy? If so, please describe the situation.

Home Environment

Does your dog listen to you inside your home?

Does your dog listen to you in your yard?

What behaviors does your dog know without hesitation while at home?

Which of these does he/she without hesitation outside the home?

Where does your dog stay during the day when no one is at home?

How does your dog behave when you’re getting ready to leave the house?

Is your dog destructive or a nuisance to neighbors in any way while you’re away?

Does he react and/or bark at dogs while looking out the windows?

Do you play with your dog?

If so, what kinds of interactions or games do you play with him?

What are your dog’s favorite toys?

Who in your family plays with your dog the most?

What do you do to reward your dog for good behavior?

What do you do to discourage undesirable behavior?

List rewards your dog absolutely loves (include food, treats, toys with specific brands, types, etc.):

Bite History

Has your dog ever made contact and/or bitten another dog?

Has your dog ever made contact and/or bitten a person?

If your answer is yes to either question, please complete the Bite History Questionnaire

Other People

What is the dog’s reaction to visitors in your home?

Describe your dog’s reaction to children visiting:

Describe your dog’s reaction to adult women visiting:

Describe your dog’s reaction to adult men visiting:

Does your dog react to accessories such as canes, large coats, or hats? If so, what accessories?

What is the dog’s reaction to adults while out and about on a leash?

Your dog’s reaction to children while out and about on a leash?

What is the dog’s reaction to people or children while off leash in an enclosed area outside of the home/yard?

Has your dog had any negative experiences with people in the past? If so, please describe

Other Quirks

Does your dog have any odd or unusual behaviors inside the home?

Does your dog have any odd or unusual behaviors in your yard?

Does your dog have any odd or unusual behaviors outside your home or yard?

Other quirks your dog has: