Request edit access
Reactivity class intake form
Sign in to Google to save your progress. Learn more
Name of owner *
Email
Name , Age, Weight, and Breed of dog *
Is your dog altered or intact *
Does your dog have any allergies. If so, to what? *
How likely is your dog experiencing physical pain or discomfort? *
If you answered Yes, Possibly or Likely, please give more information. *
Brief timeline of dog's major life events (medical procedures, health issues, relocation, pet or human absences, ect) *
Describe your dog's typical day  *
Your dog at home
(Check all that apply)
 *
Required
Your dog outside the home
(Check all that apply)
 *
Required
Your dog around people
(Check all that apply)
 *
Required
Your dog around dogs
(Check all that apply)
 *
Required
What does your dog react to?
(Check all that apply)
 *
Required
What does your dog do when they see the thing(s) they react to? *
Required
When your dog shows reactive behavior how does their body look (mark all that apply). *
Required
Your dog displays reactive behavior when their trigger is... *
Required
If a dog treat, bully stick or piece of pizza fell on the floor how would your dog react (mark all that apply): *
Required
Has your dog ever gone after and or bitten a person? If yes, please leave detailed description of the event(s) and resulting injury(s)
Has your dog ever gotten in a fight and or bitten another dog. If yes, please leaved detailed description of event(s) and resulting injury(s)
What timeline best describes your dog's reactive behavior?
Clear selection
What strategies have you used to manage or work on reactive behavior? 
Is your dog currently experiencing any health problems? If yes, what are they experiencing?
Is your dog currently on any medications? If yes, what are they taking and why?
Your dog's sleeping habits consist of (mark all that apply): *
Required
What else would you like us to know about your dog?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of West Seattle Wonder Dogs.

Does this form look suspicious? Report

Google Forms