EVALUATION DATE: ______TRAINER INITIALS: ______

OWNER INFORMATION PET INFORMATION Your Name: ______Pet’s Name: ______Phone: ______Cell: ______Current Age/Birthday: ______Address: ______Breed: ______Color: ______Email: ______Male Female Intact Neutered/Spayed

Vet: ______Vet Number: ______

Where did you obtain your dog (breeder, shelter, found)? ______When did you acquire your dog? Month ______Year ______How old was your dog when he/she was acquired? ______

List all other dogs in the household. Breed: ______Age: ______Male Female Neutered/Spayed DATE ACQUIRED: ______Breed: ______Age: ______Male Female Neutered/Spayed DATE ACQUIRED: ______Breed: ______Age: ______Male Female Neutered/Spayed DATE ACQUIRED: ______

Describe the dynamics between the dogs. Who do you perceive is the alpha? Who is the submissive dog? ______

Your home consists of: Partner/Spouse Roommate Children - GIVE AGES: ______

Is there anyone in the household that the dog has issues with? ______Does the dog have a favorite family member? ______

Who in the family does the dog show the most respect? ______What brand/kind of food does your dog eat? ______Who feeds the dog? ______Yes  Picky Normal Voracious

______

How much exercise does your dog get? Daily Walk Walk 1-3 Times/Week Couch Potato Other ______

www . the dog kno w l e d g e.c o m What is your dog’s training history? (Check all that apply) Very Basic Puppy Kindergarten Group Classes Trained Yourself Titles: ______Private Training (if so, who?): ______Dog’s favorite game: ______Favorite Toy: ______

Have you or someone else ever used a shock collar on your dog? Yes No

Yes No If yes, please describe: ______

Is your dog possessive of toys, food, or objects? Yes No If yes, please describe: ______

Does your dog show fear toward any of the following? (Check all that apply) Men Women Children Moving Objects (bicycles, vacuum cleaners, cars) Loud Noises Thunder Other, please describe: ______

Does your dog have issues with any of the following? (Check all that apply) Nails Trimmed  Cleaning Ears Baths  Rubbing Belly  Rolling Over Grasping Collar

Has your dog ever: Growled at you, or Tried to bite you or a family member? If yes, please explain: ______

Has your dog ever: Growled at, or Tried to bite a stranger If yes, please explain: ______

Has your dog ever: Growled at, or Tried to bite another dog If yes, please explain: ______

Does your dog have any of the following issues? Check any that apply: Urine Marking Chews/Licks Self Trash Can Raiding Tail Chasing Counter Surfing Jumping on People  Urinates when Excited Urinates when afraid  Licks People Sleep Disorders Timid/Shy   Barking Howling Whining  Eats own Stools Eats other dog’s stool  Pushy

Have you ever used a crate for confinement? Yes  Yes No

Was/is the crate:  Wire Other: ______

How did you hear about The Dog Knowledge? ______

What is the main reason that you have chosen The Dog Knowledge for your pet? Training Boarding Daycare  Group Classes Agility Other ______

Are there other issues that you wish to address or feel you should inform us of? Yes No

Owner Signature ______Date: ______

www . the dog kno w l e d g e.c o m Supplemental Canine Behavior Questionnaire

OWNER NAME: ______PET NAME: ______

Describe the primary problem: ______

How much of a problem do you consider the behavior to be? Very Serious Serious Not Serious

Describe the problem beginning with the most recent incident: ______

Describe previous incidents: ______

Describe the first incident: ______

What age was your dog when the problem started? ______How often does the problem occur? ______

Has there been a recent change in frequency or severity? Yes No If yes, explain: ______

Describe any changes in the home when the problem first appeared: ______

Have you actually seen the problem? Yes No If yes, what did you do? ______

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

The Dog Knowledge • 704.365.1892 • 704.365.1894 fax • 1110 ProAm Drive • Charlotte, NC 28211 • Located off Wendover Road www.thedogknowledge.com What was the dog’s response? ______

List any techniques that have had success: ______

List any techniques that, in your opinion, have made the problem worse: ______

Describe the first incident: ______

List any medications tried, and the dog’s response: ______

What do you think is the reason for your dog’s problem? ______

Have you considered rehoming your dog? Yes No Maybe Have you considered giving your dog up to a shelter? Yes No Maybe Have you considered euthenasia? Yes No Maybe

Additional comments: ______

The Dog Knowledge • 704.365.1892 • 704.365.1894 fax • 1110 ProAm Drive • Charlotte, NC 28211 • Located off Wendover Road www.thedogknowledge.com