Behavior Assessment Questionnaire

Behavior Assessment

Client Name

Home address

Email

Phone

Preferred pharmacy for prescriptions to be called in

Pet name and age

How long have you had your pet?

Where did you obtain your pet?

Breeder as a puppy

Pet store

Shelter

Private rescue organization

Private sale or adoption (Craigslist, Facebook, Nextdoor, etc)

Current medications (drug name, dose and frequency)

Current health concerns, or significant previous health concerns

Describe your behavior concerns and when they started

If not explained above, what known triggers have been identified?

What sort of exercise does your pet get, and how often?

Other pets in the home

Other family members in the home

Have you owned previous pets?

How does your dog handle loud noises?

Does your dog socialize well with other dogs?

Does your dog socialize well with other people?

How does your dog react at veterinary visits?

Has your pet ever bitten any person or dog?

No, they have never shown any aggression.

No, they have growled but nothing more.

They have snapped but never made contact.

They have made contact, but never broken the skin.

They have bitten and broken skin.

They have bitten and caused serious trauma.

If your pet has ever shown aggression, please describe.

If you are human, leave this field blank.

Name

Email

HP

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