New Client Questionnaire

Welcome to Bark to Basics

Thank you for taking the time to complete this questionnaire. The more information you can provide, the better prepared I can be for our consultation. Many behavior problems are influenced by medical history, environment, daily routine, and previous experiences, so some questions may not seem directly related to your concerns. If a question doesn't apply, simply select "Not Applicable" or leave it blank if allowed.

About You

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Are there any instructions for parking or accessing your home?

How did you hear about me?(Required)

Who can I thank for referring you?(Required)

About Your Dog

Before we discuss behavior concerns, I'd love to learn a little about your dog and their background. Every dog is an individual, and understanding their history helps me provide recommendations tailored specifically to them.

Is this your first dog?

Yes

What is your dog's name?(Required)

How old is your dog?(Required)

What is your dog's breed?(Required)

Current weight (lbs)(Required)

An estimate is fine if you aren't sure.

Sex(Required)

Male

Female

Is you dog spayed or neutered?(Required)

Yes

Approximately how old was your dog when they were spayed/neutered?(Required)

Did you notice any behavior changes after your dog was spayed/neutered?

Yes

Unsure

Please describe the changes you noticed.

How old was your dog when they joined your family?(Required)

Where did you get your dog?(Required)

Breeder's name

Shelter's name

Rescue's name

Is there anything about your dog's breeder, litter, or early puppyhood that you think would be helpful for me to know?

Examples: • Poor socialization • Illness • Bottle-fed • Large litter • Fearful puppy • Aggressive littermates

Do you know anything about your dog's life before joining your family?

Has your dog lived in any other homes before coming to live with you?(Required)

Yes

Unknown

Please tell me what you know about your dog's previous home(s), including how long they lived there and the reason for transition, if known.

Has your dog experienced any major life changes in the past year?(Required)

Illness/injury/surgery

Adoption

Moving

New family member

Death/loss of a person or pet

Person or pet moving out of the household

New baby

New pet

None

Please describe any significant life changes you selected above

Health History

Your dog's health can have a significant impact on behavior. Pain, illness, hormonal changes, vision or hearing loss, gastrointestinal disease, and certain medications can all influence behavior. This information helps me determine whether collaboration with your veterinary may be beneficial and allows me to tailor recommendations specifically to your dog.

Priimary vet doctor's name(Required)

Primary vet clinic name (if different)

May I send your veterinarian updates?(Required)

Yes

Current Health

Has your dog been diagnosed with any medical condition?(Required)

Yes

Please list your dog's medical conditions.(Required)

Examples: • Arthritis • Allergies • Epilepsy • Thyroid disease • Heart disease • Gastrointestinal disease • Orthopedic injury • Skin disease • Other

Is your dog currently taking any medications or supplements?(Required)

Yes

Please list all medications and supplements, including why your dog takes them.(Required)

Examples: Medication | Dose | Reason

Has your dog ever taken medication specifically to help with behavior?(Required)

Yes

Which medication(s) has your dog tried?

Examples: • Fluoxetine • Clomipramine • Sertraline • Trazodone • Gabapentin • Clonidine • Other

How did your dog respond?

Have you noticed any sudden changes in your dog's behavior?(Required)

Yes

Please briefly describe what changed and approximately when you first noticed it.

Did your dog's behavior begin or noticeably change after any of the following? (Select all that apply.)

Illness

Injury

Surgery

Starting medication

Stopping medication

None of the above

Is there anything else about your dog's health that you think I should know?

Daily Life and Routine

Understanding your dog's daily routine helps me make recommendations that fit your lifestyle. There are no right or wrong answers. This section simply helps me understand what a typical day looks like for your dog.

Approximately how many hours is your dog left alone on a typical weekday?(Required)

When left alone, where does your dog stay?(Required)

Loose in the house

Crate

Exercise pen

One room

Garage

Outside

Other

Where does your dog typically sleep at night?(Required)

Crate

Dog bed

Owner's bedroom

Owner's bed

Couch

Free in house

Other

How well does your dog relax when nothing is happening?(Required)

Very well

Usually settles

Occasionally struggles

Rarely relaxes

Constantly alert or active

How would you describe your dog's energy level?(Required)

How many days per week does your dog receive exercise?(Required)

Approximately how much exercise each time?(Required)

What types of exercise does your dog regularly receive?(Required)

Which forms of mental enrichment does your dog receive regularly?(Required)

Food puzzles/Snuffle mats

Stuffed toys

Scent games

Chews

Training sessions

None

What is your dog fed?(Required)

How often is your dog fed?(Required)

Does your dog have any food allergies or restrictions?(Required)

Yes

Please describe.

Is there anything about your dog's daily routine that you think would be helpful for me to know before we meet?

Household

Who lives in your home?(Required)

List names and ages

Are there other animals living in your home?(Required)

Yes

List their species, names and ages

Do visitors come to your home regularly?(Required)

Frequently

Occasionally

Rarely

Almost never

When visitors come over does your dog bark, lunge, growl, attempt to bite or bite?(Required)

Yes

Please describe your dog's behavior with visitors(Required)

Training and Learning History

Every dog learns differently, and every family has a unique training journey. Understanding what you've already tried—and what has or hasn't worked—helps me avoid repeating strategies that were unsuccessful and allows us to build on previous successes. There are no right or wrong answers. My goal is simply to understand your dog's learning history.

Has your dog received any previous training?(Required)

Yes

Which types of training has your dog participated in?(Required)

Puppy class

Group obedience class

Private trainer

Behavior consultant

Veterinary behaviorist

Board and train

Online course

Taught at home

What did you find most helpful about training?

What didn't work about training?

Which tools/methods have you used with your dog? (Select all that apply.)(Required)

Is your dog comfortable wearing the basket muzzle?

Yes

Somewhat

Which cues does your dog reliably understand? (Select all that apply.)

Please describe.

What motivates your dog the most?(Required)

Please describe.

What does your dog struggle with most?(Required)

Please describe.

Why You're Here

Tell me what brings you to Bark to Basics. This section helps me understand your goals and ensures the rest of the questionnaire focuses on the areas most relevant to you and your dog.

What would you like help with?(Required)

Puppy Training

Dog Training (Training and Manners For Adults)

Behavior Concerns (Aggression, Fear, Reactivity)

Separation Anxiety

Which Puppy Training option are you interested in?(Required)

Puppy Jumpstart - $350 in-home/$300 virtual

Prepared Puppy - $700 in-home/$500 virtual

Polished Puppy - $1,100 in home/$900 virtual

I'm not sure - I'd like help deciding

Which Dog Training option are you interested in?(Required)

Everyday Essentials - $350 in-home/$300 virtual

Everyday Excellence - $700 in-home/$500 virtual

Everyday Elevated - $1,100 in-home/$900 virtual

I'm not sure - I'd like help deciding

Which Behavior Consulting option are you interested in?(Required)

Behavior Consultation - $300 in-home/$250 virtual

Behavior and Beyond - $900 in-home/$700 virtual

Better Best Friend - $1300 in-home/$1100 virtual

I'm not sure - I'd like help deciding

Separation anxiety services begin with an initial consultation so I can learn more about your dog, discuss your goals, and determine the best next steps. Initial Separation Anxiety Virtual Consultation - $200

Behavior Concerns

What behavior concerns would you like help with? (Select all that apply.)

Aggression toward people

Aggression towards dogs or other animals

Reactivity (barking, lunging, growling to people, dogs etc)

Fear or anxiety

Resource guarding

Handling or grooming concerns

Other

Briefly describe.

When did you first notice your primary behavior concern?(Required)

Since you first noticed this behavior, it has...(Required)

Improved

Stayed about the same

Gradually worsened

Varies depending on the situation

What have you already tried to improve this behavior, and what was the result?(Required)

What are you currently doing to safely manage or prevent this behavior? (Select all that apply.)(Required)

Avoid certain situations

Keep my dog separated from people or animals

Use baby gates

Use a basket muzzle

Restrict access to certain rooms or furniture

Rotate pets using barriers

Nothing currently

Other

Please describe.

Has this behavior ever resulted in an injury to a person or another animal?(Required)

Yes

Please briefly describe what happened.(Required)

Aggression

Thank you for providing this information. The following questions help me better understand your dog's aggressive behavior so I can prepare for our consultation and prioritize safety recommendations. Please answer based on what you've observed, even if you're unsure why the behavior occurred.

Who has your dog shown aggressive behavior toward? (Select all that apply.)tled(Required)

Adults

Children

Familiar people

Unfamiliar people

Dogs in the household

Unfamiliar dogs

Cats

Other animals

Other

Please describe.(Required)

What behaviors has your dog displayed? (Select all that apply.)(Required)

Hard staring

Growling

Snarling (lip lift)

Air snapping

Snapping with contact

Biting

Chasing

Lunging

Other

Please describe.(Required)

Has your dog ever bitten a person or another animal?(Required)

Yes

Do you have any photos or videos you'd like to share before our appointment?

Max. file size: 256 MB.

Please do not attempt to have your dog display any aggressive or fearful behavior to take a video. Only share if you already have the video.

Is there anything else you'd like me to know before we meet?

Bite History

Who/what was bitten?(Required)

Adult

Child

Familiar person

Unfamiliar person

Dog in household

Unfamiliar dog

Cat

Other animal

Other

Who/what was bitten?(Required)

Adult

Child

Familiar person

Unfamiliar person

Dog in household

Unfamiliar dog

Cat

Other animal

Other

Approximately when did this occur?(Required)

Did the bite break the skin?(Required)

Yes

Did medical or veterinary treatment require more than basic first aid?(Required)

Yes

Other

Describe what happened immediately before the bite?(Required)

Describe what happened immediately after the bite?(Required)

Has your dog bitten in similar situations more than once?(Required)

Yes

Unsure

Has your dog been involved in any other bite incidents, please briefly describe.

Please share any photos of the bites you have

Drop files here or

Max. file size: 256 MB.

Fear, Anxiety and Reactivity

I'd like to learn a little more about the situations your dog finds difficult. These questions help me better understand when your dog's behavior occurs so I can prepare for our consultation.

Which situations are difficult for your dog? (Select all that apply.)(Required)

Please describe.

How does your dog typically respond in these situations? (Select all that apply.)(Required)

Please describe.(Required)

Has your dog ever made contact with or bitten a person or another animal during one of these situations?(Required)

Yes

Is there anything else you'd like me to know before we meet?

Do you have any photos or videos you'd like to share before our appointment?

Drop files here or

Max. file size: 256 MB.

Please do not attempt to have your dog display any aggressive, reactive or fearful behavior to take a video. Only share if you already have the video.

Handling

Which types of handling are difficult for your dog? (Select all that apply.)(Required)

Describe

How does your dog typically respond? (Select all that apply.)(Required)

Pulls away

Freezes

Growls

Snaps

Bites

Tries to escape

Other

Please describe.

Has anyone been injured while handling or grooming your dog?(Required)

Yes

Resource Guarding

I'd like to learn a little more about your dog's resource guarding. These questions help me understand what your dog is guarding and how they typically respond when someone approaches.

What does your dog guard? (Select all that apply.)(Required)

Food

Food or water bowls

Treats or chews

Toys

Stolen objects

Resting places

Furniture

People

Other

Please describe.

Who does your dog guard these items from? (Select all that apply.)(Required)

Adults

Children

Household dogs

Unfamiliar dogs

Cats

Other animals

What behaviors has your dog displayed while guarding? (Select all that apply.)(Required)

Please describe.

Has your dog ever bitten a person or another animal during a resource guarding incident?(Required)

Yes

Is there anything else you'd like me to know before we meet?

Do you have any photos or videos you'd like to share before our appointment?

Drop files here or

Max. file size: 256 MB.

Please do not attempt to have your dog display any aggressive or fearful behavior to take a video. Only share if you already have the video.

Separation Anxiety

Approximately how long can your dog currently be left alone without becoming distressed?(Required)

What have you observed when your dog is left alone? (Select all that apply.)(Required)

Please describe.(Required)

What does your dog typically do while you are preparing to leave? (Select all that apply.)(Required)

Please describe.

When does your dog have difficulty?(Required)

When left completely alone

When one specific person leaves, even if someone else remains

When any household member leaves

When left with family or friends

When left with a pet sitter

At daycare or boarding

At veterinary office

I'm not sure

Can your dog currently remain comfortable in any of these situations? (Select all that apply.)(Required)

With another household member

With a friend or family member

With a pet sitter

At daycare

While boarding

With another dog or pet

In the car

None of these

Other

Please describe.

Does confinement appear to affect your dog's distress when left alone?(Required)

My dog does better when confined

My dog does worse when confined

It doesn't seem to make a difference

My dog is not confined

I'm not sure

What happens when your dog is confined?

For example: barking, escape attempts, biting the crate, bending bars, drooling, or other behavior.

Have you recorded your dog while they are home alone?(Required)

Yes

Upload video

Max. file size: 256 MB.

Does your dog's response seem different depending on any of the following? (Select all that apply.)(Required)

Length of absence

Time of day

Which person leaves

Whether another person is home

Where another pet is present

Where my dog is left

It seems about the same regardless

I'm not sure

Other

Please describe.

What have you already tried to help your dog with being alone, and what happened?

Has your dog ever injured themselves or caused significant damage while trying to escape or reach you?(Required)

Yes

Please briefly describe what happened.(Required)

Do you currently have a way to avoid leaving your dog alone longer than they can comfortably handle while we work on training?(Required)

Yes

Sometimes

I'm not sure yet

What options are available to you? (Select all that apply.)(Required)

Family or friends

Pet sitter

Dog walker

Daycare

Bringing my dog with me

Working from home or adjusting my schedule

Other

Please describe.

How long would you ideally like your dog to be comfortable staying home alone?(Required)

Does your dog struggle with loud noises?(Required)

Yes

Please describe.(Required)

Is there anything else you'd like me to know before we meet?

Puppy Training

Tell me a little more about what you'd like help with during puppyhood. These questions help me focus our time on the areas that are most important to you.

Which puppy concerns would you like help with? (Select all that apply.)(Required)

Please describe.

How is house training going currently?(Required)

Going very well

Occasional accidents

Frequent accidents

We haven't started yet

Other

How does your puppy currently respond to a crate or pen?(Required)

Settles comfortably

Protests briefly, then settles

Has difficulty settling

Becomes very distressed

We aren't currently using one

How does your puppy currently do when left alone?(Required)

Comfortable

Mild difficulty but settles

Significant difficulty

Has not really been alone yet

I'm not sure

Are there any situations, people, animals, sounds, or environments your puppy currently seems worried about?(Required)

Yes

Unsure

Please describe.

What would you most like your puppy to be able to do confidently over the next few months?(Required)

Is there anything else you'd like me to know before we meet?

Dog Training

Tell me which everyday skills you'd most like to improve. This helps me focus our training plan on the areas that will make the biggest difference in daily life.

Which skills would you like help with? (Select all that apply.)(Required)

Please describe.

Where do these skills tend to be most difficult? (Select all that apply.)(Required)

At home

On walks

Around visitors

Around other dogs

In public places

Around distractions

Other

Please describe.

What would make the biggest difference in your day-to-day life with your dog?(Required)

Is there anything else you'd like me to know before we meet?