Workshop-Dog Questionnaire

Pat Miller, CBCC-KA, CPDT-KA
17816 Spielman Rd.
Fairplay, MD 21733

Workshop - Dog Questionnaire- Behaviorial
Workshop Name and Month Attending:
2. What is your dog's Name, Breed, Age, and Fertility Status?
4. How long have you had him/her?
5. Brief description of behavior(s) you'd like to work on during the workshop?
6. Description of prior and ongoing efforts you've made to try and modify the behavior(s). Please include information as to how effective they were or weren't.
7. Please list any medical conditions the dog may have had, what kind of treatment/medications s/he has been on or what the current status of the condition is.
8. Has the dog ever caused injury to another, human or non-human? If so, please describe.
9. Any other details you'd like to tell us?