CO-OWNER'S NAME AND CONTACT INFO:
Date Format: MM slash DD slash YYYY
THE HOME ENVIRONMENT
DAILY ACTIVITIES AND ROUTINE
For each of the following use a scale of 1 (poor) to 5 (excellent) to indicate how your dog responds.
Have you ever used any of the following for punishment or training?
How does the dog react to the following types of handling?
If this is a referred case, please have your veterinarian complete the medical section of this questionnaire.
DEPARTURE BEHAVIOUR SCREENING:
Indicate how your dog reacts to each of the following (check all that apply):
Situations causing aggression:
If there have been no signs of aggression (growl, bite attempts, biting) or if it has been entirely resolved, then proceed to PRINCIPAL COMPLAINT.
Please answer all of the following unless they have been entirely covered in another section:
Please answer any of the following that have not been previously discussed.