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If other, please specify.
If other, please specify.
5. How much exercise does your pet receive per day? < 1 hour < 1 hour 1 - 2 hours 2 - 3 hours > 4 hours
6. Where does your pet sleep? Dog bed Dog bed Floor Your bed Outside bedroom
7. Are there other pets in the house? Yes Yes No
8. Do they get along? Yes Yes No
9. Does your dog exhibit signs of anxiety, fear, or stress when they see somebody new inside the home? Yes Yes No
10. Does your pet exhibit any of these signs when the pet sees somebody new outside the home? Yes Yes No
11. Has your pet ever bitten anyone? (A bite is when a dog puts its mouth on a person, regardless of whether or not it breaks the skin) Yes Yes No
12. Has your pet ever bitten another dog? Yes Yes No
13. Please describe the circumstances of the incident(s) including number of times this has occurred:
14. Has your pet undergone any training? Yes Yes No
15. What type of training?
16. Has a remote correction or bark collar even been used? Yes Yes No
17. Have any training techniques been attempted to lessen signs of anxiety?
18. Have any medications or supplements (Rx or OTC) been provided in an attempt to lessen signs of anxiety? Yes Yes No
19. What were they (name, strength, frequency, length of time)?
20. Do you feel that they worked? Yes Yes No Somewhat
21. Are they still taking these medications and/or supplements? Yes Yes No Somewhat
22. Is your pet taking any other medications? Yes Yes No Somewhat
Please list medications:
23. Please share with us any additional past medical history for your dog.
