Dog Behavior History Form Name * First Name Last Name Email Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Dog's Name * Dog's Age * Dog's Breed * Age Obtained * Dog's Weight * Spayed/Neutered? * Referred By? * Veterinarian Name and Phone Number * List Any Medications: * List Any Other Pets * List Any Other Family Members in the Home (include ages for anyone under 18 years) * How would you describe your dog's problem? * How often does the problem behavior occur? * How long has this behavior been occurring? Have you spoken with your veterinarian about this behavior problem? * Thank you!
