10. Does your dog usually uncontrollably chase or attempt to chase any of the following?
Please check all that apply
Joggers
Bicycles
Skateboarders/Rollerbladers
Cars/Motorcycles
Outdoor Cats
Small Animals
Birds
Doesn’t Chase
11. How does your dog usually react when you or another family member does the following?
Please check the boxes
Never Tried
Enjoys
Allows
Afraid
Shows teeth/growls
Snaps
Bites
None of these
Bathe
Brush
Wipe Paws
12. How does your dog usually react when an unfamiliar person approaches or enters the yard or house?
Friendly
Afraid
Barks
Shows teeth/growls
Snaps
Bites
None of these
13. Is your dog potty-trained / housebroken?
Yes
No
Paper Trained
Dog Door
Other
________________________
(Please describe)
14. Where does your dog spend his/her time when you are home?
Inside – Runs Free
Inside – In Cage/Crate
Outside – Tied Up
Outside – Runs Free in Neighborhood
Outside – Runs Free in Yard
Outside – In Cage/Pen
Other (Please Describe) _______________________________________________________________
15. How long is your dog left alone, without people, during the day?
Never
1-3 Hours
4- 8 Hours
9 - 12 Hours
Over 12 Hours
16. When your dog is left alone, is he/she:
Outside
Free Inside
Confined to a Room
In a Cage/Crate
Other
_________________
(please describe)
17. When left alone, does your dog usually show any of the following behaviors?
Please check all that apply
Destroy household items
Urinate/Defecate
Bark
Cry/Howl
None of these
18. When your dog plays does he/she typically do any of the following? (please check all that apply)
Jumps
Growls
Barks
Bites Lightly
Bites Hard
None of these
19. What toys does your dog like?
Balls
Frisbee
Plush/Stuffed
Squeaky
Tug Toy
None
Other
__________________
(please describe)
20. What games does your dog like?
Fetch
Tug
Chase
Wrestling
Hide & Seek
None
Other
________________
(please describe)
No
Yes
_________________________________________
21. Is your dog afraid of anything?
(please describe)
22. Is your dog allowed on the furniture?
Yes
No
Cage/Crate
Floor
Dog Bed
Owner’s Bed
Outside
23. Where does your dog usually sleep overnight?
24. What commands does your dog know?
None
Sit
Down
Stay
Shake/Give Paw
Come
Heel
25. Does your dog know any special tricks?
____________________________________________________________
(please describe)
26. Has your dog attended any obedience or training classes?
No
Yes
_______________________
(what kind/where)
27. Has your dog ever been walked on a leash?
Yes
No
28. Does your dog have problems riding in the car?
No
Yes
___________________________________
(please describe)
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