Behavior Assessment Intake Form

,

General Boarding Form

HOME
DOG TRAINING
PUPPY TRAINING
BOARDING
BOARD AND TRAIN
PRIVATE TRAINING
REVIEWS
ABOUT
- FAQ
CONTACT
- BEHAVIOR ASSESSMENT INTAKE FORM
- GENERAL BOARDING FORM

BEHAVIOR ASSESSMENT INTAKE FORM

Behavior Assessment Intake Form

Dori Dog Training

Behavior Assessment Intake Form

Free Text

For training or training with boarding, fill out this behavior assessment intake form and a Dori Dog Training representative will contact you the next business day. The cost of the behavior assessment is $300.

First Name*

Last Name*

Phone Number*

Email*

Address Line 1*

Adress Line 2

City*

State*

Zip Code*

How many Adults and Children live in your home?*

How did you hear about us?*

Free Text

Dog of Concern Information

Dog's Name*

Dog's Age*

Dog's Weight*

What Breed is your dog?*

Does your dog have any significant past or present medical conditions?*

List any medications your dog is currently taking:

How long have you owned your dog?*

Does your dog have a current rabies vaccination?*

Is your dog neutered/spayed?*

Where does your dog sleep at night?*

Do you routinely walk your dog on a leash?*

Do you use a crate for your dog?*

What kind of exercise does your dog get? How often?*

How many hours during daylight does your dog use the crate?*

Free Text

Other Animals in the Home

Do you have any other dogs? Please list the name, age, breed, and weight of your other dogs.*

Do you have any other pets? This includes, cats, rabbits, birds, and farm animals.*

Free Text

Behavioral Problems

Does your dog...

Whine or bark in the crate?*

Yes

No

N/A

Urinate Indoors?*

Yes

No

N/A

Have difficulty dropping items like toys, or clothing?*

Yes

No

N/A

Constantly pull on a leash?*

Yes

No

N/A

Defecate when excited or scared?*

Yes

No

N/A

Run away, or hide while holding material items?*

Yes

No

N/A

Jump up on you, or your guests?*

Yes

No

N/A

Constantly beg, or demand attention?*

Yes

No

N/A

Steal items from counter tops, like food, or towels? (Counter surfing)*

Yes

No

N/A

Chew things they shouldn't, like clothes, furniture, kids toys, etc.?*

Yes

No

N/A

Growl, lunge, or bark while eating from a bowl or off the ground?*

Yes

No

N/A

Guard food, bones, or toys, by growling or lunging?*

Yes

No

N/A

Growl, lunge, or bark with toys or similar items?*

Yes

No

N/A

Uncontrollably chase, or stare, at lights, shadows, or reflections?*

Yes

No

N/A

Become grumpy or annoyed when startled or awaken from sleep?*

Yes

No

N/A

Get excited/jealous when you give attention to another dog/person?*

Yes

No

N/A

Run away when you try to put a leash or collar on?*

Yes

No

N/A

Bark, or whine when left alone?*

Yes

No

N/A

Follow you, or anyone in the house from room to room?*

Yes

No

N/A

Get mouthy, or nippy when too excited or playful?*

Yes

No

N/A

Have difficulty coming when called?*

Yes

No

N/A

Have any problems being crated?*

Yes

No

N/A

Bump into you, walk between your legs, or knock you over while on a leash?*

Yes

No

N/A

Nap, or relax under tables, chairs, beds, or sofas?*

Yes

No

N/A

Lean on, or push against your legs when they are scared or nervous?*

Yes

No

N/A

Is your dog tense, skittish, nervous, anxious, or fearful?*

Yes

No

N/A

Nip, bite, or peck with their mouth when physically challenged with humans?*

Yes

No

N/A

Sleep while pushing up against your feet or body?*

Yes

No

N/A

Pace, pant, drool, or whine while traveling in a car?*

Yes

No

N/A

Pee multiple times while on a walk away from your home?*

Yes

No

N/A

Dislike being touched in the paws, ears, or rear end?*

Yes

No

N/A

Kick up grass, or dirt, after using the bathroom?*

Yes

No

N/A

Bark at dogs, people, or small animals on a leash?*

Yes

No

N/A

Whine while getting ready to leave the house for a walk, or travel?*

Yes

No

N/A

Bark or chase people or animals behind your fence?*

Yes

No

N/A

Free Text

When was the last time your dog...

Met a new person, or stranger?

Met a new dog?

Walked on a leash outside of your home, or off property?

Has been to a veteranarian's office?

Bit a human?

Bit a dog?

Harmed, or killed any other animal?

Endured a drastic environmental change; such as moving homes, being adopted., losing a family member, or companion dog etc.?

Endured a traumatic incident, such as being physically abused, neglected, abandoned, or hit by a car?

Free Text

Significant Behavioral Tendencies

For the following questions, please indicate whether your dog currently has, or has previously had significant incidents with the following types of humans, and/or other animals. Significant incidents include incessant barking, growling, lunging, tensing, snapping, charging, biting, hiding from, or killing the following types of humans, and/or other animals.

Children, toddlers, babies?

Yes

No

N/A

Family members, or roommates?

Yes

No

N/A

Primary owner(s), or handler(s)?

Yes

No

N/A

Friends, guests, or visitors in the home?

Yes

No

N/A

Friends, or strangers off the property?

Yes

No

N/A

Other dogs in the home?

Yes

No

N/A

Other animals; such as cats, bird, rabbits, deer, livestock, etc.?

Yes

No

N/A

The veterenarian, or groomer?

Yes

No

N/A

Non-companion dogs off of your property?

Yes

No

N/A

If you answered

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Oops, there was an error sending your message.
Please try again later.

Visit Us

,

Contact Us

(570) 927-2606

Business Hours

Mon - Fri: 8:00 am - 9:00 pm
Sat - Sun: Closed

Weekend and After Hours as Needed, Call for Flexible Scheduling. Flexible or Last-Minute Scheduling Accepted. Saturday and Sunday Hours Vary.

Hi. Do you need any help?

Share On:

Privacy Policy | Do Not Share My Information | Conditions of Use | Notice and Take Down Policy | Website Accessibility Policy

© 2024 The content on this website is owned by us and our licensors. Do not copy any content (including images) without our consent.

Share by:

{{placeholder_retargeting_pixel}}

{{placeholder_dpni}}

{{placeholder_footer_reserve3}}

{{placeholder_footer_reserve4}}

{{placeholder_footer_reserve5}}

{{placeholder_footer_reserve6}}

{{placeholder_footer_reserve7}}