Behavior Assessment Intake Form

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General Boarding Form

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BEHAVIOR ASSESSMENT INTAKE FORM

Behavior Assessment Intake Form

Dori Dog Training

Behavior Assessment Intake Form

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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?*

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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?*

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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.*

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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

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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?

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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!

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