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Reactive Dog Program Assessment Questionaire
Full Name:
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
Other
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?
Submit
Should be Empty: