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 Last Name *
Your Pet's Name *
Breed of your dog/cat *
Age of your pet *
Sex
Clear selection
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). *
Please describe the MOST recent incident that exemplifies the behavior problem(s)
Please include any additional information you feel may be helpful in further diagnosing the problem. Include any previous treatments, if appropriate
If you pet is spayed or neuter, at what age what she/he spayed or neutered?
If you pet is spayed or neuter, for what reason were they spayed or neutered?
If you pet is spayed or neuter, did you notice any behavior changes after spaying or neutering?
If you pet is NOT spayed or neutered, do you plan to breed them?
How old was your pet when you first acquired him/her?
Has your pet had other owners? If so, how many previous owners and why were they re-homed? *
How long have you had this pet?
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? *
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? *
What percentage of the day does your pet spend outside? *
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)?
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.
Are there any other pets in the household? If yes, please list all pet's name(s), breed(s), sex, age.
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?
What does your pet do as you prepare to leave? *
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?
Clear selection
(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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