Behavior Help Questionnaire Name Name * Address * Street Address City State Zip Code Phone * Email Address Preferred time to be reached? * What is your pet's name? * How old is your pet? * Sex of dog * Spayed female Neutered male Female Male What breed is your dog? * Did you adopt your pet from the Animal Protective Foundation? * Yes No If not, where did you obtain your pet? How long have you had your pet? * What behavior problem are you experiencing? * Are you considering giving up your pet because of this behavior problem? * Yes No How long has this behavior problem been going on? * When does the behavior happen most often? * Please describe the behavior problem in more detail. * Has your pet been examined by a veterinarian to rule out medical causes for this behavior? * Yes No Are there any recent changes in your home (recent move, nearby construction, vacation, visitors, new baby, new pets)? * What is your dog's training history? * Trained by me Attended group classes Private lessons with a trainer Have you previously worked with a trainer to address this behavior? Yes No How was your dog trained? (Check all that apply) * Treats Clicker Praise Leash corrections E-collar/Shock collar Squirt bottle Pet corrector Physical corrections Please know that the APF asks for this information only so that we can gather history and further help you with your concerns. Please describe your pet's daily routine including walks, exercise, mealtimes, and where (s) they are kept when you're gone. Number of children below age 14 in the home * Are there other pets in the home? Yes No If yes, please list type and quantity. What are your goals (i.e. dog parks, neighborhood walks, add another pet, etc)? *
