Contact information

Person's name*

Address*

Phone number*

Email address*

How did you hear about the Behavior Helpline? (check all that apply)*

Pet information

Dog's name*

Age*

Gender*

Breed(s) or best guess*

Dog's weight (or best guess)*

Where did you get your dog?*

How long have you had your dog?*

Who is your veterinarian?*

Does your dog have any medical issues, including allergies? If so, please describe.*

If your dog is taking any medication, please list the drug and dosage*

What brand of food do you feed?*

How many cups of food do you feed each day?*

What is your dog's feeding schedule? Check all that apply.

What are your dog's favorite treats or snacks?*

What are your dog's favorite toys or games? (ex. fetching ball, frisbee, tug of war, etc.)*

Has your dog received any formal training? If so, please list the trainers/organizations you've worked with*

Please check all the equipment you've used with your dog.*

Describe your dog's exercise routine (activity, distance/duration, frequency, locations, etc.)*

Where does your dog sleep at night?*

What is your typical schedule for work or school?*

Where is your dog when left alone?*

How often is your dog left alone?*

Household information

If you have other people in your household, list them below (please include ages of children)*

Describe your dog's behavior and relationship(s) with human family members

If you have other pets in your household, please describe them below (species, breed, age, gender, spayed/neutered, etc.)*

Describe your dog's behavior with other pets in the household.

How does your dog react when strangers come to the door?*

How does your dog react after guests enter your home?*

Behavior concern

Describe your dog's concerning behavior. Please be as detailed as possible (where it happens, how often, specific details, etc.)*

When did this behavior start?*

Were there any environmental or lifestyle changes that occurred around the time your dog's behavior changed? If so, please describe. (ex. moved, had baby, different roommates, job schedule change, etc.)*

What do you do when your dog exhibits this behavior?*

How does your dog react to your response?*

What changes (if any) have you made due to your dog's behavior?*

Have you consulted your veterinarian about this behavior? If so, what was the result?*

Has your dog ever bitten or injured a person? If so, provide details including circumstances leading to the incident, nature of injury, and level of medical attention needed.*

Has your dog ever bitten or injured another animal? If so, provide details including circumstances leading to the incident, nature of injury, and level of medical attention needed.*

Are you considering re-homing your dog?*