Dog & Puppy Behavior Profile

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Please fill this out before your scheduled session. If you have not yet contact me for scheduling, please return to my website to fill out request for a quote and availability. If your behavior issue concerns more than one pet species, please use separate cat/kitten form. Your initial consultation fee includes assessment of information from this form. Thank you! -Rochelle (she/her)

Your Name & pronouns *

Your preferred contact email

Household members Names & Ages; include any other household pets or pets/family who visit frequently

Your dog's Name, Age, & breed(s). If unknown breed, please indicate size of dog. *

Rate your experience level with pet guardianship *

First time pet owner

Very experienced/advanced training knowledge

Is your dog spayed or neutered? *

Spayed

Neutered

Not spayed yet, but will be in the future

Not Neutered yet, but will be in the future

I do not plan on altering my dog

undecided about this; I would like more information about spay/neuter

Describe your pet's normal daily routine and feeding schedule. Where does dog sleep at night? Type of food (kibble, wet, fresh/raw) and brand of food is helpful. If routine varies, give example of each day (ex. weekend schedule vs. weekday) *

List behavior concerns you are experiencing with your dog or why you are scheduling this appointment. Please list name of referral if applicable. *

Does your dog have a bite history? *

No, but has air snapped and/or lunged at someone or at another pet (level 1 bite)

Yes, but has not drawn blood (level 2 bite)

Yes, has drawn blood; punctured a person or pet (level 3 bite)

My dog has bitten a person or dog multiple times during one event or has killed a pet (level 4 or higher)

I am not sure - I adopted this dog as an adult without any background info.

My puppy is mouthy during playtime

My dog has redirected a bite on me or another person during a fight with a dog

Other:

Required

Have you talked to your veterinarian about your dog's behavior issue(s)? *

Yes

Yes, and my Pet is currently taking behavioral support medication

Yes. My veterinary behaviorist recommended contacting a certified pet trainer for DS/CC

Other:

Are you considering rehoming or surrendering your dog to a shelter due to behavioral issue(s)? *

Yes

Maybe

My Landlord requires proof of training / resolving of behavior issue in order for me to keep the dog(s)

If behavior issue is not resolved soon I cannot keep my pet(s)

When and where does the problem behavior start? What makes it stop? How do you respond when the problem behavior occurs? *

Describe your training style & training equipment. Have they worked for you in the past? (e.g. treats/praise, front clip harness, choke chain, head halter, muzzle, martingale collar, mixed positive reinforcement & mild aversives, 'pack leader' style, Punishment and verbal praise only (no treats), verbal reprimands and leash corrections, no training (or not sure)

How long have you lived with your dog? When did behavior issue(s) begin? *

Select any recent changes that have occurred (</=3mos. unless otherwise noted)

Recent home change (</= 9 months ago)

additional new pet in home or apt. building

Household pet passed on (< 1 year ago)

Change in household members

Negative encounter with another animal, person, or impactful environmental stressor(s) such as fireworks, construction, etc.

Daily routine has changed

frequent wildlife or community cat appearances in vacinity

irregular sleep patterns or energy levels

Abnormal appetite (significant increase or decrease)

Location or frequency of meals has changed

Dog's diet/type of food has changed

Allergies/seasonal irritants have increased

New training equipment or type of training has varied

injuries or medical conditions

Other:

Where did you find your dog? *

A certified professional breeder

Family member or friend

Adopted from shelter or rescue organization

I found the dog as a stray

Craigslist or online network

I am fostering this dog temporarily

Other:

What are your training goals for your dog? (e.g. reliably come when called, housetraining, resolve reactivity/fearfulness, loose leash walking, ESA training, resolve separation related behavior issues, advanced obedience/specific task work, etc.) *

Anything Else I should know? My goal is to make training fun and accessible for all. Please notify me of any mobility concerns, food allergies (for humans or pets), special circumstances, or special needs you or your pet may have and I will accommodate you to the best of my ability.

How did you hear about me?

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