Behavior History Form
For Behavioral Consultations, please complete the form below and submit it for review. Registration forms & current vaccination records are required to be submitted 72hrs prior to your scheduled appointment. Good Pup Club reserves the right to cancel and refund any appointment if the required registration forms & current vaccination records have not been received 72hrs prior to the appointment.
Consultation Date/ Time:
First Name:
Last Name:
Other adults that will be present, or live within the home:
Dog's Name:
Dog's Age:
Dog's sex:
Male
Female
Dog's weight:
Breed type:
How long have you had your dog?
Dog's age when acquired:
Where did you get your dog?
If your dog is adopted, what information, if any, do you have about his/her previous life?
Is your dog spayed/ neutered? If so at what age?
How many people in household?
How many children, names & ages:
Other dogs in household, names & ages:
Other pets in household, names & ages:
Your experience level:
First time owner
Somewhat experienced
Experienced
Veterinarian:
List any medications your dog is taking:
Please describe your dog's behavior problem(s), go into as much detail as you wish.
What has been done so far to correct the problem? Types of discipline, confinement, training, etc.
What was your dog's response to these corrective measures?
Have you consulted a behavior specialist or taken a training class with your dog?
How often do you feed your dog?
Twice daily
Three times daily
Free feeding
What type of food?
What kind of exercise does your dog get on a daily basis?
Does your dog go to daycare or have a dog walker?
Does your dog have any physical problems?
How long is your dog left alone?
What makes your dog bark?
Do you know whether your dog plays/played at dog parks, whether official or casual? If so, when and how often?
Frequently
Occasionally
One or two times
Never
Is your dog overprotective of any of the following?
Food
Toys
Property
You or another person
Has your dog ever been attacked? If so, at what age?
Three (or more) activities that your dog likes/loves:
Three (or more) foods that your dog likes/loves:
What are your goals for your dog?
Is there anything else you'd like us to know?
Date
Your Signature
*
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