Your Name

First Name

Last Name

Dog's Name(s)

First Name

Last Name

Overview

How many times has your dog bitten a person?

How many times has your dog bitten another dog?

Have you received a court order to hire a dog trainer to evaluate or train your dog?

Medical

Had your dog recently experienced a surgery or infection at the time of the bite?

Did your dog receive any wounds from another animal at the time of the incident?

Bite History On Dogs or Other Animals

What age was your dog when he/she first bit another animal?

Is your dog protective over his food with other animals?

Is your dog protective over his toys with other animals?

Describe the situation that occurred that caused each bite:

Had your dog recently experienced a stressful event at the time of the bite? If so, which one and what happened?

How serious was each bite?

Did the bite(s) require a veterinary visit?

Yes

Was there a surgery or stitches required?

Bite History on Humans

Is your dog protective over certain areas of his body? If so, which parts?

Does your dog let you groom him/her? What areas of his body is he uncomfortable with you touching?

Is your dog protective over food with people?

Is your dog protective over toys with people?

Describe the situation that occurred that caused each bite to a human:

Please describe the bite(s): (e.g. puncture, tear, bruising, etc.)

Had your dog recently experienced a stressful event at the time of the bite(s)? If so, what?

Did the bite require a hospital or doctors visit?

Was there a surgery or stitches required?

Follow Up Questions

Describe situations that make your dog nervous or uneasy:

Have you ever considered rehoming your dog? If so, why?

Have you ever considered euthanasia? If so, why?