Behavioral History Form


Pat Miller, CBCC-KA, CPDT-KA
17816 Spielman Rd.
Fairplay, MD 21733
info@peaceablepaws.com
www.peaceablepaws.com
301-582-9420

 

Please answer the following questions and submit the completed form.

Specific questions about the problem behavior(s) will be asked during your visit.

Please bring your dog’s medical records with you.

Payment methods accepted: Cash, check or credit card (Visa, Mastercard, Discover, American Express) in person, or PayPal at the website.

Cancellation policy: Appointments cancelled less than 48 hours in advance will be charged a $50 rescheduling fee. Appointments cancelled 48 hours or more in advance may be rescheduled without penalty. No penalty for appointments rescheduled due to inclement weather.

You are welcome and encouraged to take notes, and to audiotape or videotape your session.

Please note: We are a teaching facility as well as a training center. Peaceable Paws staff and/or apprentices may sit in on your session.

Submission of this behavioral history form constitutes permission to share your information with a consulting veterinarian.

Behavioral History Form
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Please describe several examples in detail

Please list all animals in the household, including the dog you are bringing,
in the order in which they were obtained.

AGGRESSION SCREEN (Please check all that apply)

FOR AGGRESSION TOWARDS PEOPLE
(Skip this section if aggression is not the problem)