Behavior Questionnaire
Please complete these questions, as fully as you feel you are able prior to your behavior consultation appointment. All questions are confidential and are used to help us better evaluate your pet.
Your First Name *
Your answer
Your Last Name *
Your answer
Your Pet's Name *
Your answer
Breed of your dog/cat *
Your answer
Age of your pet *
Your answer
Sex
Please describe in as much detail as possible what the primary behavioral problem or problems are. Please include how long the behavior issues have been occurring, where it occurs, who (if anyone) is present when it occurs, and what the trigger may be (if known). *
Your answer
Please describe the MOST recent incident that exemplifies the behavior problem(s)
Your answer
Please include any additional information you feel may be helpful in further diagnosing the problem. Include any previous treatments, if appropriate
Your answer
If you pet is spayed or neuter, at what age what she/he spayed or neutered?
Your answer
If you pet is spayed or neuter, for what reason were they spayed or neutered?
Your answer
If you pet is spayed or neuter, did you notice any behavior changes after spaying or neutering?
Your answer
If you pet is NOT spayed or neutered, do you plan to breed them?
Your answer
How old was your pet when you first acquired him/her?
Your answer
Has your pet had other owners? If so, how many previous owners and why were they re-homed? *
Your answer
How long have you had this pet?
Your answer
Where did you get this pet? (select all that apply) *
Required
What is the primary purpose for getting this pet? (select all that apply) *
Required
What is the average number of hours your pet is left alone each weekday? *
Your answer
Is your weekday schedule consistent? *
Where is the pet when he/she is left alone? (select all that apply) *
Required
What percentage of the day does your pet spend inside? *
Your answer
What percentage of the day does your pet spend outside? *
Your answer
What kind of living situation do you have? *
Where is your pet at night? (select all that apply) *
Required
How many times is your dog or cat let outside per day? *
If your pet is walked, what is the average time for each walk (in minutes)?
Your answer
How many meals does your pet get each day? *
How often is your pet fed treats (cat treats, dog biscuits, chews) each day? *
How often do you feed your pet snacks from the table (i.e. human food) each day? *
Does your pet have any preexisting medical issues? If yes, please explain.
Your answer
Are there any other pets in the household? If yes, please list all pet's name(s), breed(s), sex, age.
Your answer
Has your household had any significant changes since adopting this pet? If so, how? (select all that apply) *
Required
Have you had dogs before? *
Have you had a cat before? *
How often do you play with toys or play games with your pet indoors on a daily basis? *
How often do you play with toys or play games with your pet outdoors on a daily basis? *
Please describe in some detail, how you prepare to leave the house when the pet will be left alone. For example, do you ignore your pet, do you seek it out and say goodbye, do you make a fuss over it, etc?
Your answer
What does your pet do as you prepare to leave? *
Your answer
How would you describe your pet's personality? (select all that apply) *
Required
Does your DOG regularly (at least weekly) engage in the following: *
No
When owner is present
When owner is absent
Unsure
Excessive barking/whining
House soiling
Destructive chewing
Self licking/chewing
Digging
Pacing, repetitive behavior
(Cats only) How many litter boxes do you have?
(Cats only) What kind of litter material do you put in the litter box(es)? (select all that apply)
(Dogs only) Do you the following training aids? (select all that apply)
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