Thank you in advance for completing this detailed questionnaire!
This information will help me to understand your puppy’s situation, behavior and training issues so we can get started training right away!

General Information
Today’s Date:

Your Name:
Address:
Home Phone:
Cell Phone:

How were you referred to K9-Behavior Company?

Puppy’s Name:  
Puppy’s Breed:  
Puppy’s Sex: Male or Female  
Puppy’s Birth Date or Age:  
Puppy’s Vet Clinic:  
How much does your puppy weigh approximately?  
Is your puppy over or under weight?  
Is your puppy spayed or neutered?       		If so, at what age?

What prompted you to decide to get training or behavior modification assistance now?  Is there some specific incident that caused you to seek assistance?  

Briefly describe your puppy’s personality (quiet, confident, excitable, unruly, timid, fearful, aggressive, busy, etc)  

How old was your puppy when you got it?  

From whom/where did you get the puppy?  

Do you have any specific information about previous owner history or behavior problems?  

What motivated you to get a puppy and this particular breed?  

Please describe any current medical problems your puppy may have and if your puppy is on any medication?  

Date of last rabies vaccination?             Date of last DHLPP vaccination?  

Do you have any special health or living circumstances that must be considered in keeping your puppy?  
(Eg. allergies, asthma, neighbors sensitive to noise or puppy activity, mobility limitations, etc) 

Specific Training / Behavior Concerns

Please list the specific behaviors your puppy does that concern you and prompted you to seek help.  For each, what would you like your puppy to do instead, and what you have tried already?

Example: Fido bites us mercilessly with his sharp teeth. I’m afraid he will hurt us and the kids. And he runs around like a crazed dog in the evening after dinner.  I’d like him to lick instead or just bite his toys.  We tried squeezing his nose and saying “No Bite” but it does not seem to help.   We are now keeping him away from the kids when he gets excited because they don’t like his biting.

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In addition to regular play & exercise, how much time are you able or willing to spend training your puppy?
	More than below
	3 - 10 minute sessions per day  
	2 -10 minute sessions per day  
	1 -10 minute session per day  
	3 -10 minute sessions per week  
	2 -10 minute sessions per week  
	1 -10 minute sessions per week  
	less than above

Feeding

What kind/brand of food do you feed your puppy?

How many times per day do you feed?

Do you leave the food bowl down for the puppy most of the day?

Does your puppy have any food allergies or special diet considerations? Please specify.

What are your puppy’s eating habits? (voracious, picky, eats when s/he wants)

If you leave food for your puppy, will s/he eat while you are gone?

If your puppy is over or under weight what are you doing to change that?

Has your puppy ever lunged, growled, or snapped at anyone around his/her food bowl?

Home Environment
Where does the puppy sleep at night?

Where is the puppy during the day when you are home?

How many hours per day does the puppy spend home alone?

Where is the puppy when you are not home?

Does your puppy do unwanted behaviors (eg. chewing, digging, barking, or escaping) or cause damage to things or him/herself when you are gone?

Do you give treats to your puppy? What type, how often and under what circumstances?

Does your puppy take food or treats from your hand gently?  How about from other family members or strangers? 

Can you easily take things (food, toys, chew bones) away from your puppy without him/her trying to keep the item, growling, running or snapping at you?

Do you have/use a crate for your puppy? For what purposes & does the puppy like the crate?

Activities with Puppy

List the puppy’s daily play and or exercise and how many minutes per day does s/he do each?

Puppy’s Favorite game:

Puppy’s favorite toy:

What are your puppy’s top 5 favorite things to have or do in priority order? (eg, treats, specific toys, specific games like tug or fetch, activities like swimming, chasing squirrels, etc.)

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2
3
4
5

Does your puppy know any tricks? Which ones?

What types of collars do you use? Check all that apply.

Flat buckle collar
Choke chain
Martingale (limited slip flat)
Pinch or Prong Collar
Leather flat
Gentle Leader
Halti
Harness
Invisible Fence Collar
Bark Collar
Shock Collar
Other

 Family Members

Please list family member names (ages if children), and how they get along with the puppy:
Examples:
Sally	10 yrs old	Sally & puppy play together all the time
Trina	3 yrs old	Trina is afraid of the puppy because it bit her when she took puppy’s bone
Howard – dad		Puppy loves Howard – they play tug games every day

List other family pets, species, sex, acquired before or after the puppy, and how they get along:

Examples:
Bird	male		had before	bird is caged & they don’t interact
Cat	female		had before	cat avoids puppy; puppy chases cat, cat runs never caught yet

Has the puppy ever growled at, snapped at a family member? What were the circumstances?

Handling

How does your puppy react to the following types of handling?  
1 = hates    2 = tolerates    3 = indifferent   4 = likes    5 = loves

Trimming Nails			
Brushing Teeth			
Bathing			
Grabbing Collar			
Examining feet, belly, tail, & ears	
Vet examination			
Being lifted				
Putting on collars & leashes		
Getting into the car			
Being asked to get off the bed/sofa	

Socialization

Where and how often do you currently take your puppy for socialization to new people, noises, the environment, etc.? How does it go on these outings?  

Did your puppy attend a “puppy socialization” class at about 8-16 weeks of age?

How many NEW PEOPLE does your puppy meet each week (i.e. people your puppy does not know)? _______

How does your puppy react to the following types of people? 
0 = is aggressive      1 = is shy or does not like  	2 = is indifferent	3 = is happy/loves 

Unfamiliar People
People in Uniforms
Men
Children
Teenagers
Women
Other Unfamiliar Dogs
Other Familiar Dogs

How many times has your puppy bitten a person; family member or other non-family member?
What were the circumstances each time it happened?

What was the severity of each of the bites?
	Did not break skin – left spit only
Did not break skin – but bruised
Broke/Scratched skin
One-hole puncture or tear
2-4 hole puncture
More extensive damage to skin

Has your puppy been in fights with other dogs? 	How many?
Out of those fights, how many times did either of the dogs have to go to the vet for treatment?

Training History

Did you attend any other classes or training with your puppy? 
Where, what type & how many sessions?
Did they use food treats in class?		Did they use collar corrections in class?

Which cues does your puppy know? 
3 = really well      2 = most of the time      1 = only sometimes      0 = doesn’t know

Sit		
Down		
Stay		
Come		
Walk on a Loose Leash	
Fetch		
Drop it		
Leave it	

How do your reward your puppy when s/he does what you ask?

Which of the following methods, if any, have you used to correct your puppy’s behavior?
Put a * by the ones that work best.
Put an X by the ones that don’t work well.
Put a W by any that make the behavior worse.
Leave blank if you have not used the method.

Swatting or Hitting
Pushing Away
Confinement
Verbal Reprimands
Shaker Cans
Alpha Roll-over
Choke Chain Corrections
Holding Nose Firmly & Saying No
Kneeing in the Chest
Turning Away
Squeezing Paws
Water Sprayer
Time-outs
“Actively” Ignoring
Give puppy something else to do
Shock Collar Correction
Other – please describe

Have you ever used a ‘clicker’ to help train your puppy?   Are you interested in learning how to use one?

Other Potential Issues

Below is a list of potential problem behaviors.  Please note any which you may also have questions or concerns about.

Digging	
Chewing	
Barking	
Howling		
Whining
House soiling/marking – urine	
House soiling – feces	
Urinating when excited or frightened	
Stool Eating	
Chasing	
Hunting or Predatory Behavior	
Jumping up on family or guests	
Jumping onto furniture where not allowed	
Stealing food off counters	
Raiding garbage	
Escaping from yard	
Running away		
Not coming when called	
Self-chewing	
Mounting children or others	
Shy of People		
Shy of Things		
Shy of Noises	
Biting		
Aggression	
Bad when Home Alone	
Phobias	
Begs at Dinner Table	
Pulls on Leash		
Other?????		

Thank you again for completing this questionnaire!
Please return to Deborah Walker by email at
K9BTraining@gmail.com or mail to:

Deborah Walker
K9-Behavior Company
PO Box 656
Wilbur, Oregon  97494