Reactive Dog Program Questionnaire Form

Address

Phone Number

Area Code Phone Number
Email
example@example.com
Dog's Name and Breed:

Name Breed
How old is your dog?
Sex:

Neutered Male Spayed Female Intact Male Intact Female
Where did you get your dog?

Rescue Shelter Breeder
How long have you had your dog?
Please describe your dog's reactive behavior for example (lunges and/or barks at other dogs):
Has your dog been in an altercation with another dog?

Yes No
If yes, was veterinary care necessary? Explain...
Has your dog shown reactivity toward humans?

Yes No
What have you done so far to correct your dog's behavior problem?
When did you first notice the problem? Why do you think the dog is exhibiting the behavior problem?
Has your dog ever attended doggie daycare? If so, how long did he attend?
Does your dog have dog friends or has play dates with certain dogs?
Should be Empty:

Reactive Dog Program Assessment Questionaire