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Medical / Behavioral Form

Medical

Client information:

Please complete these forms as thoroughly as possible. Your answers will be helpful in identifying patterns and pathways to behavioral change.

Owner’s Name*

Email*

Street Address*

Phone Number*

Behavioral History

Training

Has your dog received training?*

No training

Trained them ourselves

Puppy group training

Basic group training

Intermediate group training

Advanced group training

Private lessons

Sent to board and train

List organization/trainer’s names.*

List training methods used. (treats or food, praise, verbal corrections, physical corrections)*

Next to each behavior your dog knows, estimate what percentage of the time they will do so when asked. If your dog doesn’t know a behavior, type 0%*

Does your dog know any other behaviors or tricks that are unlisted?*

Is your dog reliably housetrained?*

Is your dog crate trained?*

Is your dog paper/pad trained?*

Is your dog litterbox trained?*

Describe inappropriate behaviors that apply to your dog and include details. *

Aggressive

Fearful

Jumps on people

Pulls on leash

Destructive when left alone

Mouthing or nipping

Chews furniture/property

Digs in yard

Urinated in the house

Urinates when excited

Defecates in the house

Darts out doors/gates

Escapes from yard

Guards food/toys/other things or places

Excessive attention seeking

Jumps on furniture

Play-biting

Stool consumption

Understands but will not obey

Excessive vocalization while alone

Threatening/growling at other animals

Other

Please describe any behaviors noted above including location, duration, intensity, etc.*

List any training equipment/procedures you have used to try to correct issues listed above.*

What would you like help with, in order of importance.*

lynne@lynnepawstraining.com

Name

Phone

Reason for inquiry

Urgency of need

Best day/time for phone contact

Major concerns

Were you referred by someone?

Thanks for submitting!

Allow 24 hours for response to inquiry

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