Dog Aggression Consultation

Step 1 of 6

16%

Name*

Address*

City*

Zip code*

Email*

Occupation*

Home Phone*

Veterinarian/Clinic*

How Did You Hear About Me?

PET INFORMATION

Pet’s name*

Breed*

Age*

Weight*

Sex*

Male

Female

Neutered*

Yes

Age neutered | Any change after neutering?

Age Obtained*

Where did you obtain this pet?*

Breeder, if applicable

Please describe the behavior of parents and/or littermates

REASON(S) FOR PRESENTATION

Please list behavior problems in order of importance: (realize that some cases have multiple issues and may have to be addressed separately)

Describe the problem behavior

Intensity

Severe

Moderate

Mild

Length of time problem has existed

Frequency of problem (eg.once weekly, daily)

Add 2nd Issue

Yes

Describe the problem behavior

Intensity

Severe

Moderate

Mild

Frequency of problem (eg.once weekly, daily)

Length of time problem has existed

Add 3rd Issue

Yes

Describe the problem behavior

Intensity

Severe

Moderate

Mild

Frequency of problem (eg.once weekly, daily)

Length of time problem has existed

INFORMATION ON PRESENTING COMPLAINT(S)

What do you think has caused the problem(s)?

Describe the problem/misbehavior – make sure to include such descriptions (if possible) of the dog’s body posture, locations of other people or animals in the vicinity, circumstances that you believe stimulated the problem, etc

Describe previous incidents

Has there been a recent change in frequency of the behavior?

What has been done so far to try and correct the problem?

What has been the dog’s response?

List any techniques that have been successful

List any techniques that have made the problem worse

List any drugs that have been tried so far and the dog’s response to the medication

Mg strength

Drug

Frequency (e.g. once a day, twice a day)

Length of time drug administered (e.g. days, 2 weeks, 1 month)

Outcome (successful or not)

List any other dietary treatments, supplements or remedies and the dog’s response:

FAMILY / RELATIONSHIPS

List each family member living in the home with the pet (include sex and age)

Member Name

Sex

Age

How does your dog get along with each family member?

Who feeds?*

Who plays?*

Who grooms?

Who trains?

Who gives treats?

Who exercises/walks?

Briefly describe the family schedule, including how long the dog is left alone:

List the pets in your household:

Name

Species

Breed

Sex Spayed/neutered?

Age obtained

Age Now

How do the pets get along with each other?

TRAINING

Any formal training?*

Yes

Class*

Private instructor

Trained at home

How successful was training?

Is there any ongoing training?*

Yes

Describe

Type of training collar used: |

Dog’s response

Neck collar

Remote collar (if yes, indicate type e.g. shock, citronella, etc)

Head halter (such as Gentle Leader®, Halti®)

Body Harness

Other (choke, pinch, prong)

How would you describe the training?

Reward-based

Assertive/dominance

Aversive/mostly corrections

Other

How well does your dog obey the following commands (when asked for the FIRST time) for each household member? (list as a percent)

Household member

Sit

Down

Stay

Come

Are there any other commands or tricks your dogs knows?

Punishment

Physical punishment

Yes

Reaction to physical punishment

Noise punishment (shaker can, noise)

Yes

Reaction to noise punishment

Ultrasonic (e.g. Petagree®)

Yes

Reaction to Ultrasonic

Water Sprayer

Yes

Reaction to Water Sprayer

Verbal reprimands

Yes

Reaction to Verbal reprimands

Physical handling: muzzle grasp pinning

Yes

Reaction to Physical handling: muzzle grasp pinning

Time out

Yes

Reaction to Time out

Booby traps/repellents

Yes

Reaction to Booby traps/repellents

Handling

How does your dog react to the following types of handling?

Nail trimming

Giving pills

Brushing

Hugging/kissing

Rubbing belly

Patting head

Grabbing collar

Lifting

Rolling over

Bathing

Medical Screen

Are there any past or present illnesses?

Any painful conditions?*

Yes

Please describe

Diet: (Brand, dry/canned)*

Describe appetite*

Voracious

Normal

Finicky

Decreased

Any changes in stool?*

Any change in drinking?*

Less

Same

Any change in urination?*

Same

More frequent

Less frequent

Larger volumes

Smaller volume

Any food intolerance?*

Yes

Is your pet on any other medications? (besides the drugs listed under primary behavior complaint ) Make sure to include supplements

Is your pet on any other medications?

DRUG NAME

DOSAGE

FREQUENCY GIVEN (times per day)

DURATION OF MEDICATION

REINFORCEMENT ASSESSMENT

If your dog were allowed to have any treat, what would he/she prefer?*

List top five:

What other types of rewards does your dog enjoy?*

(play toys, walks, attention / affection). List top five:

HOUSE TRAINING SCREEN (If your pet is not housesoiling, skip this section)

Was your dog ever completely house trained?

Yes

At what age was he/she considered house trained?

How often does your pet house soil? (ie. several x/day, weekly or monthly?

Is it urine, stool or both?

When is the dog most likely to house soil?

Do you have a doggie door?

Yes

Does your dog use the doggie door?

Yes

In what rooms does your dog tend to soil?

Is there a room/location in which the dog does NOT soil?

Does your dog soil when family members are home?

Does your dog soil directly in front of a family member?

What do you do when you find urine or stool in the improper location?

Does your dog urine mark? (urinate on upright objects)

How many times per day does your dog have a chance to go outside to eliminate?

How long is the longest confinement without access to outside? (if any)

Is your dog crated?

Yes

Is there ever urine in the crate?

Yes

Does your dog leak urine when

Sleeping?

Walking?

Approached by owner?

If approached by stranger?

Excited?

Frightened?

Departure Behavior Screen

How long is the dog left alone on an average day?*

Is the dog left*

Indoors

Outdoors

Access to both

Is your dog crated or confined on departure?*

If crated, describe crate

Location of crate?

If confined other than crate, describe

Has your dog been left at a kennel, veterinary clinic or with family/friends?

If yes, describe your dog's reaction

Does your dog exhibit any problem behaviors on your departures?*

Yes

If yes, continue with following questions, if no, please skip to the next section:

Describe your dog's behaviors when left alone:

Does the behavior differ depending on length of departure or the time of day left alone?

How does your dog act as you or other family members are getting ready to leave? Describe:

Does the behavior differ depending on who is the last to leave the home?

How does the dog react when the family returns?

Have you ever left the dog alone in the car? If so, how did he/she react?

AGGRESSION SCREEN

Has your pet displayed any of the following?

Threatening behavior?*

Yes

Growling?*

Yes

Bite attempts?*

Yes

Bites?*

Yes

If your pet has displayed any of the above, but they have been resolved, or controlled to your satisfaction, then skip next section and proceed to the next:

Situations that lead to aggression
(check all that apply)

Petting/handling

Growled

Attempted to Bite

Bit

No Reaction

Eating or being approached while eating

Growled

Attempted to Bite

Bit

No Reaction

Chewing stolen toys/objects attempting to take away from dog

Growled

Attempted to Bite

Bit

No Reaction

Trimming nails/bathing/brushing

Growled

Attempted to Bite

Bit

No Reaction

Staring at dog

Growled

Attempted to Bite

Bit

No Reaction

Scolding dog

Growled

Attempted to Bite

Bit

No Reaction

Leash or collar correction

Growled

Attempted to Bite

Bit

No Reaction

Physically reprimanding dog

Growled

Attempted to Bite

Bit

No Reaction

Raising hand over dog

Growled

Attempted to Bite

Bit

No Reaction

Bend or lean over dog

Growled

Attempted to Bite

Bit

No Reaction

Hug or kiss dog

Growled

Attempted to Bite

Bit

No Reaction

Grabbing collar

Growled

Attempted to Bite

Bit

No Reaction

Rolling over

Growled

Attempted to Bite

Bit

No Reaction

Disturbing while sleeping

Growled

Attempted to Bite

Bit

No Reaction

While dog is on furniture/bed, attempting to remove dog

Growled

Attempted to Bite

Bit

No Reaction

Aggression towards people: If your pet is not aggressive towards people, skip this section and move to the next:

In your opinion, what is the potential for injury to another person?

Has your dog ever bitten hard enough to break skin or cause injury?

Yes

Describe

Number of bites that have broken skin?

Total # of bites

Body parts typically bitten

If your dog has bitten a person, how old was the dog the first time he/she bit?

Months

Year

Has your dog ever been aggressive toward members of the immediate family?

Yes

Describe

Is your dog ever aggressive toward visitors?

Yes

Describe

Is your dog aggressive toward people off property?

Yes

If yes, were the people known, strangers or both? Explain

Is there a particular person or type (age, sex, uniforms) that you dog is most likely to threaten or bite?

Yes

Describe

Is there a particular location or situation where aggression is most likely to occur?

Yes

Describe

When your dog threatens, attempts to bite or bites, how do you handle the situation and what is the dog’s reaction?

How would you describe your dog’s attitude at the time of aggression? (bold, protective, fearful, etc)

How would you describe your dog’s expression and postures at the time of aggression? (hackles raised, ears forward or tail back, tail up or tucked between legs and under, cowering, running forward and then retreating):

Aggression towards other dogs

If your dog is not aggressive towards other dogs, skip this section and move to the next:

In your opinion, what is the potential for injury to another dog?

How old was your dog when you first noticed aggression to other dog(s)?

Months

Years

Has your dog ever bitten hard enough to break skin or cause injury requiring medical attention?

Yes

Describe

Number of bites that have broken skin?

Total # of bites

Body parts typically bitten

Is there a particular location or situation where aggression is most likely to occur?

Yes

Describe

Aggression toward other dogs, check all that apply

Aggression toward other dogs

Investigates the other dog before attacking

Tries to attack from a distance

What is the usual distance away from another dog when attempting to attack?

Barks/growls before attacking

Does not bark or growl before attacking

Gives body language such as stiffening, hair raising and staring before attacking

Attacks only bigger dogs

Attacks only smaller dogs

Size of the dog does not matter

Attacks only female dogs

Attacks only male dogs

Gender of the dog does not matter

Bites once and retreats

Bites multiple times and retreats

Bites and does not let go

Additional Behavior Problems

Destructive chewing

Yes

Describe

Barking

Yes

Describe

Whining

Yes

Describe

House soiling urine

Yes

Describe

House soiling stool

Yes

Describe

Stool eating

Yes

Describe

Jumps up (owners)

Yes

Describe

Jumps up (guests)

Yes

Describe

Garbage raiding

Yes

Describe

Food stealing

Yes

Describe

Pushy – wants own way

Yes

Describe

Only listens when feels like it

Yes

Describe

Sexual habits: Masturbation, Roaming, Mounting, Urine Marking

Yes

Describe

Chews/licks self: (if a problem, note location on body and frequency)

Yes

Describe

Tail biting

Yes

Describe

Imaginary fly chasing

Yes

Describe

Staring at / chasing imaginary objects

Yes

Describe

Hunting / predation

Yes

Describe

Uncontrollable urination when excited

Yes

Describe

Uncontrollable urination when frightened

Yes

Describe

Bedwetting (while sleeping)

Yes

Describe

Eats non-food items (Pica)

Yes

Describe

Licks objects

Yes

Describe

Excitability

Yes

Describe

Overactivity

Yes

Describe

Phobias (thunder / cars etc)

Yes

Describe

Shyness / timidity (nonaggressive)

Yes

Describe

Additional problems not listed

Yes

Describe

CAPTCHA

Aggression Consultation

Aggression Consultation

PET INFORMATION

REASON(S) FOR PRESENTATION

Please list behavior problems in order of importance: (realize that some cases have multiple issues and may have to be addressed separately)

INFORMATION ON PRESENTING COMPLAINT(S)

FAMILY / RELATIONSHIPS

TRAINING

Type of training collar used: |

Dog’s response

Punishment

Handling

How does your dog react to the following types of handling?

Medical Screen

Is your pet on any other medications? (besides the drugs listed under primary behavior complaint ) Make sure to include supplements

REINFORCEMENT ASSESSMENT

HOUSE TRAINING SCREEN (If your pet is not housesoiling, skip this section)

Departure Behavior Screen

If yes, continue with following questions, if no, please skip to the next section:

AGGRESSION SCREEN

Has your pet displayed any of the following?

If your pet has displayed any of the above, but they have been resolved, or controlled to your satisfaction, then skip next section and proceed to the next:

Situations that lead to aggression (check all that apply)

Aggression towards people: If your pet is not aggressive towards people, skip this section and move to the next:

Aggression towards other dogs

Aggression toward other dogs, check all that apply

Additional Behavior Problems

Situations that lead to aggression
(check all that apply)