Courteous Canine, Inc.

Name*

Email*

Address*

Phone*

What pronoun do you prefer?

She/Her/HersHe/Him/HisThey/Them/Theirs

How did you hear about us?*

Requested Dates for Board and Train:*

Pet Name*

Breed*

Birthday*

Sex*

Spayed or Neutered *

YesNoUnknown

How long have you owned this dog? (rounded in years)*

Where did you get this dog? (Please list name of shelter, breeder, etc.)*

In addition to you, list the names and ages of all people and animals in the household, including yourself*

Has your dog been seen by a board certified Veterinary behaviorist or a vet for any behavior problems?*

YesNo

Is your dog aggressive towards people? *

YesNo

Has your dog ever bitten a person?

YesNo

Please describe any incidents.

Is your dog aggressive towards other dogs? *

YesNo

Has your dog ever bitten another dog?

YesNo

Please describe any incidents.

Does your dog get along with cats?*

YesNo

Is your dog aggressive toward small animals (cats, chickens, etc.)? *

YesNo

Please describe any incidents.

Is your dog reactive and/or fearful of other things (bikes, vacuum, etc.)? *

YesNo

If yes, please explain:

Is your dog reactive and/or fearful of any of the following (select all that apply):? *

Does your dog pull on the leash or have any problems while walking? *

YesNo

How often do you walk your dog?*

List any equipment you use to walk your dog: *

Does your dog jump/climb fences?*

YesNo

If yes, what type/height:

Do you have a fenced yard for your dog? *

YesNo

If you don't have a fenced yard, how do you take your dog outside (check all that apply):

What type of exercise does your dog get on a regular basis (at least one time per week or more)? Check all that apply: *

If Other, please describe:

Please list how your dog rides in a car: *

If Other, please describe:

Does your dog ride well in a car?*

YesNo

If no or sometimes please explain what the problems are:

Which most closely describes how your dog eats?*

Food is the best part of the day – barely stops to breathe Food is good – eats everything at a reasonable paceFood is so/so – may or may not finish a meal or needs "extras" to make it appetizingFree feed – food is out all the time

Does your dog bark a lot? *

YesNo

If so, list what he/she barks at (or situations in which they bark) and anything you've done to try to prevent it.

Does your dog jump on company?*

YesNo

Are you okay with this or is it something you prefer they not do?

I'm okay with itI would prefer they not do it

Does your dog jump on furniture? *

YesNo

Are you okay with this or is it something you prefer they not do?

I'm okay with itI would prefer they not do it

Does your dog chew or destroy any human items in the house or yard? *

YesNo

If so, please describe and also include anything you've done to try to prevent/correct it.

What treats does your dog like?*

Do they like to play with toys?*

YesNo

What kind of toys does your dog have/how many?*

What, if any, chewies do you offer them (rawhides, bones, etc.)?*

Is your dog house trained? *

YesNoPartly

If you answered no or partly, what methods have you used?

Have your methods been successful?

When and how often does your dog have accidents in the house? *

Are the accidents in front of you or hidden?

Where does your dog stay while you are gone?*

Is your dog loud or destructive while you are gone? *

YesNo

If yes, please describe in detail:

Where does your dog spend most of their time when you are home?*

How long does your dog sleep at night?*

Where does your dog sleep at night (dogs may need to be kenneled at night for safety)?*

Is your dog okay sleeping in a crate?*

YesNo

If your dog slept in a crate how long would they bark for before settling down? *

Does your dog vocalize, urinate, or defecate while crated?*

YesNoDo not use crate/Unknown

If yes, please explain:

What, if any, formal training have you done with your dog? *

Was this with another trainer or by yourself?

How many classes/sessions did you do?

How much follow through did you do?

If you worked with a professional trainer, who did you work with and what did you like or not like?

What cues does your dog know? Please check all that apply:*

VACCINE INFO: DHLPP*

Expiry Date

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Bordetella - Expiry Date:*

Canine Influenza - Expiry Date:

Leptospirosis - Expiry Date:

Rabies - Expiry date:

Board and Train Behavior Questionnaire

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