ABC'S: ANIMAL BEHAVIOR CONCERNS & SOLUTIONS
A Question & Answer Forum For Animal Professionals
Copyright © By Diana Guerrero

All content © by Diana L. Guerrero unless otherwise noted and may not be reprinted without prior written permission. All rights reserved. Contact arkanimals.com for reprint permissions and fees.

Welcome to the ABC's! Animal Behavior Concerns & Solutions is an animal behavior column written by animal behaviorist and animal trainer, Diana L. Guerrero. This document is for pet owners who have dog behavior problems, cat behavior problems who want help and have paid for a pet behavior consultation (Visit the shop to pay.). Please fill out the online form or print and fill this form out completely and submit prior to your appointment. For other pet training concerns please visit the pet section, see our pet behavior booklets in the shop, or visit our teleseminar section.

Pet & Companion Animal Questionnaire

ANIMAL BEHAVIOR QUESTIONNAIRE
Date Completed:
For items you may not know or do not apply please put N/A.
All items are vital to help properly assess your situation.
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PROBLEM BEHAVIOR(S)
1) Briefly describe problem
2) the age when first observed
3) how long the problem has been in existence
4) where it occurs
5) what particular situation it occurs in
6) frequency of occurrence
7) how you have attempted to correct it
8) Use additional sheets if necessary!

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HUMAN INFORMATION

Name of owner working on this problem:
Mailing address (Street or PO Box):
City, State:
Zip Code:
TIME ZONE: P M C E Other
Work Phone: ( )____________________________
Home Phone: ( )____________________________
In case of emergency, notify:

Phone: ( )________________

Other Household Members
1.
Relation
Age
Feeling about pet/problem

2.
Relation
Age
Feeling about pet/problem

3.
Relation
Age
Feeling about pet/problem

4.
Relation
Age
Feeling about pet/problem

What are the former or current occupations of adult members
of the household? (This IS important)

Where did you hear about us or who referred you?

Have you ever attended a training program or behavior
seminar before? Y_____N______

If Yes, Did you complete the program?
Y___N___ Certificate awarded? Y___N___

Who conducted the program or seminar?

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ENVIRONMENT INFORMATION

My/our living environment is a:
House___Duplex____Apartment____Townhome/Condo___
Retirement Home___Ranch____Other (Please define)

Does your residence have a private yard or garden?
Y___ N____

Please list the other animals in the same household:
Name
Breed/Species
Gender*
Age
Compatibility with this pet

Name
Breed/Species
Gender*
Age
Compatibility with this pet

Name
Breed/Species
Gender*
Age
Compatibility with this pet

Name
Breed/Species
Gender*
Age
Compatibility with this pet

*Please note neutered animals with an N next to gender.

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ANIMAL INFORMATION

Pet Call Name:_____________________
Breed/Species:
Sex: M__F__
Neutered? Y__ N__ If yes, at what age?
Age:
Approximate Birthday:
List any health or physical problems:

Is this animal on medication? Y__N__
If yes, What?
Why?
Was this pet ever seriously injured or ill?___
If so, please explain:

Is your pet current on all required immunizations? Y__ N__
Does this animal have a valid license?__
What age was the pet first vaccinated?
Veterinarian Name:
Clinic Name:
City State:
Phone ( )

Age this pet was obtained:___________________
From where?_______________________________
Approximate price paid? ___________________
Age taken from mother?______________________
Litter behavior/birth order?___________________
How long have you had this animal?_____________
Do you intend to show or breed this animal? Y__N__
If yes, explain:
Is this pet allowed inside the house? Y__N__ Where?
Is your pet allowed outside the house? Y__N__Where?
If your pet was more mannerly would you allow
more inside privileges? Y__N__
Where does this pet sleep?

Where does the pet eat?
Does this pet have its own food bowl?
Who feeds the pet?
Brand name of pet food:
Semi moist:___Canned:____Dry:___
Daily feedings 1__2__3__Free Feed____
Supplements?:

Is your pet currently restrained? Y__N__How?
Length of restraint per day?
How often is your pet exercised or played
with per week?
What types of games are played?

Has this pet ever received any formal training? Y___N___
At what age?
Trainer's Name:
City:
Phone:
Did you complete the training program with this pet? Y__N__

How have you reinforced good behaviors?
How have you reprimanded for bad behaviors?
Pet's reaction to these actions?:

Has your pet growled or bitten anyone?
What were the circumstances?:
How many times has this occurred?
When/How long ago was the last time?
In stress situations (new situation, strangers, visitors,
left alone, confinement, etc.,), how does this pet react:

Would you describe your pet as:
Wild__Active__Confident,__ Assured__
Reserved__Withdrawn__Stiff__
Lethargic__Fearful__Unsure__

OTHER NOTES:

You may fax the answers through (760) 875-6874 or email them.

Are you a reader with a question? Be sure to submit it--and good luck in all your training endeavors!

About the columnist: Since 1978 Diana L. Guerrero has worked professionally with both wild and domestic animals. Guerrero has been affiliated with and certified by a variety of animal programs in the USA and Europe. Based in California, she writes, consults, and leads safaris. Information on her animal career programs, training courses, and her books, What Animals Can Teach Us about Spirituality (SkyLight Paths, 2003), Blessing of the Animals (Sterling, 2007), Help! My Pet is Driving Me Crazy (Guerrero Ink, 2007), Animal Disaster Preparedness for Pet Owners & Pet Professionals (Guerrero Ink, 2007) are available through this web site. Questions for ABC's should be submitted to Diana directly through the ABC's zoo questionnaire on this web site, or contact her now.