Behavior Conditions

Behavioral Conditions
Questionnaire
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Tell us about your pet! Help us get to know your pet on a more personal level by answering a few questions and bringing the printed form with you to your next appointment.

This questionnaire consists of 3 main sections (History, Aggression & Cognitive; beginning with your Basic Information), with roughly 30 questions each. It should only take 20 to 30 short minutes, so grab your beverage of choice and let's see how well you know your pet!

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Basic Information







Pet's Sex:        
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History

Environment

Type of House

What type of house do you live in?




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History

Environment

Sleeping Arrangement

Where does your pet sleep?






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History

Environment

Pet Source

Where did you get your pet?






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History

Environment

Age Acquired

The age of your pet when you acquired it?



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History

Environment

Number of People

How many people are in your house other than yourself?




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History

Environment

Neutered

Has your pet been neutered?

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History

Environment

Food Form

Some behaviors are caused by the type and consistency of the food you feed your pet. What type of food form do you feed your pet?



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History

Environment

Food Brand

What type of food do you feed your pet?







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History

Environment

Who Feeds

Who feeds your pet in your house?




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History

Environment

When Fed

You should feed your pet on a set schedule so that both you and your pet can have a regular routine. How often do you feed your pet?




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History

Environment

Treats

If you are consistent on when you give your pet treats, then it will help with the long-term training goals. When do you give your pet treats?



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History

Environment

Table Food

Feeding table food to your pet may develop undesirable behavior such as begging. Do you feed your pet table food?





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History

Environment

Table Food Reaction

How does your Pet React to Table Food?



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History

Exercise and Play

Hours Outside

What is the amount of time your pet spends outdoors?





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History

Exercise and Play

Restraint

This is the type of enclosure you use outside for your pet such as a fence, leash, chain, etc. What do you use?



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History

Exercise and Play

Walks

Walking your pet helps both you and your pet because the amount of time spent walking and the frequency of walks helps keep both the owner and the pet healthier. How often do you walk your pet?






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History

Exercise and Play

Leash Type

The type of leash you use on your pet has a great deal to do with how he/she responds to training. What type of leash do you use on your pet?



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History

Exercise and Play

Play Type

What items or things you and your pet play with contributes to the long-term behavior of your pet. Things or items such as balls, ropes, shoes, etc. are all types of play. What is your usual type of play with your pet?




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History

Exercise and Play

Play Frequency

Playing with your pet may contribute to their behavior. How often do you play with your pet?




O


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History

Problem History

When did it Start -Lifestage

At what lifestage did the problem begin?



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History

Obedience

Obedience Training

Obedience training is a way to help you get better control of your dog, however, it is not the best way to solve behavior problems. You will learn how to teach your dog sit, down, come when called, not to jump and so on, but not how to deal with separation anxiety or aggression. Did your pet attend obedience training?



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History

Obedience

Head Halter Trained

This means that your pet is trained with a Gentle Leader, Halti or other head halter device. These are humane ways to train your pet and gain control without excessive force or the use of chain or prong collars. Head halters are similar to horse halters and give you control over your pet's head with the idea being that where the head goes; the body will follow. These halters will not only allow you to walk your dog with ease but they also hit pressure points around your pets neck and muzzle that help calm them down. Was your pet trained with a head halter device?

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History

Obedience

Crate Trained

Your pet has been trained to respect his/her crate and this is their safe haven and sleeping area. Does yor pet respect his/her crate?


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History

Obedience

House Trained

This indicates that your pet has been house trained and understands the difference between eliminating inside versus outside. Is your pet house trained?


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History

Obedience Commands

Stay

This is an obedience command that means stay here until I come back to you and release you. With basic training, your pet learns to stay in one spot while you walk away from them. In advanced training, your pet will learn to stay where you tell them while surrounded by distractions. This command is helpful when your pet gets away from you and crosses a busy street or when your hands are full of groceries. Does your pet stay?


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History

Obedience Commands

Heel

This is an obedience command that means to walk beside your leg. Heel is a very specific command that means your pet should have their muzzle level with your leg and be within 2 inches of you. For average walks where you are only interested in your pet not pulling you, then a command of "Walk" is more appropriate. Does your pet heel?


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History

Obedience Commands

Down

This is an obedience command that means to lie down. It is very important that you are consistent with this command and when you want your pet to get off of the couch or counter, you say off and not down. If you use down in both contexts, then you will confuse your pet about what the command actually means. Does your pet obey when you tell him/her to lie down?


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History

Obedience Commands

Sit

This is an obedience command that means for your pet to get into a sit position or have their rump on the floor. Does your pet obey when told to sit?


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History

Obedience Commands

Come

This is an obedience command that means "stop what you are doing and come over and sit in front of me." In basic work, you will work on calling your dog from a distance of six feet and have them come and sit in front of you. In advanced work, you will increase the distance and then your pet will learn to work with distractions. This command is very helpful when you need to get your dog away from something. Does your pet come when you call him/her?


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Aggression

Aggression History

Bitten Human or Animal

Has your pet ever bitten a human or another animal?



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Aggression

Aggression Reaction Test

How does your pet react to:

Being Petted while Eating Delicious Food?












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Aggression

Aggression Reaction Test

How does your pet react to:

You Touching their Bowl while Eating Delicious Food?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Petted while Eating Food?












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Aggression

Aggression Reaction Test

How does your pet react to:

You Touching their Bowl while Eating Food?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Petted while Eating Rawhide?












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Aggression

Aggression Reaction Test

How does your pet react to:

You Touching their Rawhide while Eating?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Petted while Resting in a Preferred Spot?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Petted while Resting?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Petted while Sleeping?












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Aggression

Aggression Reaction Test

How does your pet react to:

You Putting on their Collar?












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Aggression

Aggression Reaction Test

How does your pet react to:

You Pulling on their Collar?












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Aggression

Aggression Reaction Test

How does your pet react to:

You Putting on their Leash?












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Aggression

Aggression Reaction Test

How does your pet react to:

You Pulling on their Leash?












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Aggression

Aggression Reaction Test

How does your pet react to:

Handling their Feet?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Hugged?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Brushed or Combed?












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Aggression

Aggression Reaction Test

How does your pet react to:

You Taking away their Favorite Toy?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Reprimanded in a Loud Voice?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being at the Veterinarian's?












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Aggression

Aggression Reaction Test

How does your pet react to:

Being Restrained at the Veterinarian's?












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Aggression

Aggression Reaction Test

How does your pet react to:

A Strange Dog Approaching while Walking?












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Aggression

Aggression Reaction Test

How does your pet react to:

A Strange Dog Entering your Yard?












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Aggression

Aggression Reaction Test

How does your pet react to:

An Unfamiliar Child Approaching?












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Aggression

Aggression Reaction Test

How does your pet react to:

An Unfamiliar Child Petting your Dog?












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Aggression

Aggression Reaction Test

How does your pet react to:

A Stranger Approaching You?












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Aggression

Aggression Reaction Test

How does your pet react to:

A Stranger Entering your Yard?












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Aggression

Aggression Reaction Test

How does your pet react to:

A Stranger Walking past your Home?












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Aggression

Aggression Reaction Test

How does your pet react to:

A Jogger Running past your Dog?












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Cognitive

Confusion, Awareness, Spatial Orientation

Gets Lost in Familiar Locations

This means your pet cannot remember his or her way around familiar places, such as the house or backyard.



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Cognitive

Confusion, Awareness, Spatial Orientation

Gets Stuck or Cannot Navigate

This means once your pet is in a particular area, he/she cannot remember the way back or out. They may become confused or scared and will stay in one area for long periods of time.



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Cognitive

Confusion, Awareness, Spatial Orientation

Goes to Wrong Side of Door (Hinge)

This means your pet has forgotten the usual way they move through the door.



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Cognitive

Confusion, Awareness, Spatial Orientation

Less Responsive to Stimuli

This means your pet no longer responds as he/she previously did to petting, showing toys, treats, invitations to play or walks, or sounds and sight.



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Cognitive

Activity -Decreased (apathy)

Decreased Appetite or Disinterest

A decreased appetite can be an indication of many illnesses from behavioral problems to medical problems, and additional tests and evaluations will be necessary to determine the cause.



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Cognitive

Activity -Decreased (apathy)

Decreased Exploration or Activity; Apathy

This means your pet has trouble exploring new and old places and has a reduced activity level known as apathy.



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Cognitive

Activity -Decreased (apathy)

Decreased Self-Care

This means that your pet is no longer licking (grooming) himself/herself, but is urinating or defecating on himself/herself. These behaviors are signs that something is wrong, such as a sign of old age, separation anxiety, illness, stress or some other behavioral problem.



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Cognitive

Activity -Increased or Repetitive

Increased Appetite

An increased appetite can be an indication of behavioral or medical conditions and additional tests and evaluations may be necessary to determine the cause.



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Cognitive

Activity -Increased or Repetitive

Licking Owners or Household Objects

This means your pet has developed a habit of licking you, the owner, or objects in the house.



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Cognitive

Activity -Increased or Repetitive

Pacing or Aimless Wandering

This means your pet has developed a habit of wandering around the house without purpose.



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Cognitive

Activity -Increased or Repetitive

Staring, Fixation, or Snapping at Objects

This means your pet has started staring at objects and fixating on them along with snapping at them more frequently.



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Cognitive

Activity -Increased or Repetitive

Vocalization

This means your pet exhibits behaviors of barking, whining, howling or singing.



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Cognitive

Anxiety or Increased Irritability

Increased Irritability

This means your pet is easily irritated more often.



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Cognitive

Anxiety or Increased Irritability

Restlessness or Agitation

This means your pet has become restless and agitates easily.



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Cognitive

Anxiety or Increased Irritability

Separaton Anxiety

This is a panic disorder that your pet has when left alone. The most common signs are destructive behavior, vocalization, inappropriate elimination, depression, excessive licking, vomiting, diarrhea, and excessive drooling. Destructive behavior, which is part of normal adolescent behavior, is widespread throughout the house, while destructive behavior due to separation anxiety focuses mainly on windows and doors. It is very important to gradually get your puppy used to being left alone by taking short trips away at first, like 5-15 minutes, and then increase them to 30 minutes, one hour, etc. It is not a good idea to confine a dog that suffers from separation anxiety while you are gone, even though it might decrease the destruction, it will only make matters worse for your pet. If you think that your pet suffers from this disorder, then please talk to a member of our healthcare team so that we can create a training program to help you solve this behavior issue and possibly prescribe some medication, such as Clomicalm, to help out during the process.



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Cognitive

Sleep-Wake Cycle

Increased Daytime Sleep

This means your pet has increased the amount of daytime sleep he/she requires.



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Cognitive

Sleep-Wake Cycle

Restless Sleep or Waking at Night

This means your pet has developed a habit of sleep walking or walking at night, which may be that your pet has forgotten or switched its internal clock.



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Cognitive

Relationships and Social Behavior

Alterations or With Social Hierarchy

Your pet no longer understands his/her role in the family and this may be happening as your pet matures and attempts to establish a new role for himself/herself. This could also happen as your pet ages or as the result of trauma.



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Cognitive

Relationships and Social Behavior

Decreased Greeting Behavior

This means your pet no longer greets you with the same enthusiasm as he/she used to.



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Cognitive

Relationships and Social Behavior

Decreased Interest in Petting Contact

This means your pet's interest in being petted or having contact while petting has reduced.



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Cognitive

Relationships and Social Behavior

In Need of Constant Contact (Clingy)

This means your pet has difficulty leaving your side and he/she wants attention more often than before and appears clingier.



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Cognitive

Learning and Memory -Work, Tasks, Commands

Decreased Ability to Perform Tasks

This means your pet may understand your requests and desire to perform certain tasks, however, he/she seems physically unable to perform them.



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Cognitive

Learning and Memory -Work, Tasks, Commands

Decreased Cognition of People or Pets

Your pet has trouble recognizing familiar people or other pets. This could be due to aging or a brain injury.



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Cognitive

Learning and Memory -Work, Tasks, Commands

Decreased Responsiveness to Commands

This means your pet may understand your requests and desire to perform certain tasks, however, he/she seems physically unable to perform them.



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Cognitive

Learning and Memory -Work, Tasks, Commands

Impared Working Ability

This means an injury or illness is preventing your pet's ability to perform working tasks.



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Cognitive

Learning and Memory -Work, Tasks, Commands

Inability or Slow to Learn New Tasks

This means your pet has difficulty learning new tasks.



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Cognitive

Learning and Memory -Housesoiling

Decreased Signaling

This means your pet no longer makes you aware of his/her need to go outside.



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Cognitive

Learning and Memory -Housesoiling

Elimination in Crate or Sleeping Area

This means your pet has problems with eliminating in the crate or sleeping area, which may mean your pet has forgotten or has lost the ability to hold urine and stool.



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Cognitive

Learning and Memory -Housesoiling

Goes Outdoors, Eliminates Indoors

This means your pet has difficulty remembering that the elimination station is outside. Your pet may be confused and will need personal attention to help remember when and where to eliminate.



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Cognitive

Learning and Memory -Housesoiling

Incontinence

This means your pet seems to be unable to control defecation or urination.



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Cognitive

Learning and Memory -Housesoiling

Indoor Elimination at Random Sites

This means your pet has started eliminating in the house at odd places.



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