Behavior Questionnaire
Instructions: Fill out Questionnaire, choose Accept & Submit. Upon review, I will contact you to schedule eval.
List Names, Ages & Relationship of everyone in Home
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Describe your living situation (apt. condo, house)
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Is dog Spayed or Neutered?
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Has this Dog had other Owners? If yes, how many & how long
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How many other Dogs do you have? Describe
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Describe what causes the stress/arousal issues?
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In events/class, how do you respond to the dog's issues?
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What classes have you taken for the problem? What worked?
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Have you worked with another trainer? Describe
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What are the "everyday life" behavior Issues?
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What Interventions have you tried? Describe
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Have you had any recent life changes (Divorce, death, move, etc)
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How do you correct your dog for something you don't like? How often? Which behaviors?
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Describe any electronic fencing, collars or other electronic corrective devices you have used?
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How do you reward behavior that you like? How often & which behaviors?
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Has Dog bitten any Humans? Describe
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Has Dog bitten other Dogs? Describe each incident & detail if Vet visit necessary
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Does Dog have Pre-existing Medical Conditions? Describe
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Is Dog anxious in your absence or in car? Describe
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How does your Dog act on Leashed Walks? Describe
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How often does your dog meet New Humans & Dogs? Describe
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What Commands & Tricks does dog know?
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What is Dog's favorite game?
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What do you like BEST about this Dog?
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Ideally, what do you want dog to do instead of the unwanted behaviors?
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WAIVER
I hereby acknowledge I have voluntarily applied for dog owner/handler training, fitness, or related services, conducted by Canine Culture, LLC. I fully understand that such training and services pose numerous risks to the health and safety to myself and my dog. I freely and knowingly assume these risks, which include, but are not limited to, the following representative examples, which are not intended to be all-inclusive: the risks of the owner/handler being bitten, scratched, soiled, tripped, yanked, jerked, attacked, frightened, or otherwise injured by other dogs in the classes, or by the owner/handler's own dog; the risks of tripping over or slipping upon floor matting, dogs, or dog-training related objects, or slipping on dog drool or dog solid or liquid waste matter, or colliding with dogs, other human participants, dog training props, dog jumps, dog obstacles, dog gating or building parts, including but not limited to, walls, doors, and support beams. I do not hold Canine Culture, LLC, its members, officers, agents trainers, and employees responsible for any damages, injuries, or liabilities caused by my animal. Also, I will not hold Canine Culture, LLC, its members, officers, agents and employees legally or financially responsible for any injury to my dog or myself. I understand that I am responsible for my dog and its actions, and understand that the Colorado Dog Bite Law holds me responsible to pay compensation for any injuries sustained to any person other than the trainer.
I give Canine Culture, LLC my permission to use any photos or videos of myself & my dog for marketing and/or training purposes.
REFUNDS: are given only in case of medical or other emergency. By applying for a Behavior Evaluation you are reserving a spot in my Schedule. Full Refunds given with 24 hrs notice.
Cost is $150 for a full Evaluation