Reactive/ anxious Dog Questionnaire Question Title * 1. Does your dog display any of these behaviors when he/she encounters a person, dog or specific object? (mark all that apply) Barks Lunges Growls Snaps or Bites Cowers Runs Away Hides None of these OK Question Title * 2. How would you describe your dog’s birth parents? Did not meet either parent Both were outgoing and seemed relaxed Both seemed to have some fear/anxiety One was relaxed and one was fearful/anxious Only met one - he/she seemed relaxed Only met one - he/she seemed anxious OK Question Title * 3. Was your dog socialized with people, other dogs, new environments and novel objects before he/she was 6 months? No, my dog was kept in the house until he/she was 6 months (or until fully vaccinated) Yes, my dog was exposed to many people. dogs, new environments and novel objects before 6 months of age. I did not have my dog until he/she was older than 6 months OK Question Title * 4. Did your dog experience any traumatic events prior to 1 year of age? Yes, was scared by a person Yes, was scared by another dog Yes, was scared by a person and a dog Yes, was scared by something else No, never experienced a traumatic event OK Question Title * 5. What training tools have used with your dog? (mark all that apply) Treats Toys Choke chain or pinch collar Harness Regular buckle collar E collar Clicker Gentle Leader OK Question Title * 6. Does your dog have any sound phobias? (mark all that apply) No Yes, fireworks Yes, thunder Yes, other loud sounds OK Question Title * 7. Does your dog exhibit any of the following when left alone? (mark all that apply) Vocalizes (barks, whines, howls, etc.) Destroys objects (furniture, toys, door frame, etc.) Urinates or Defecates Greets you overly excitedly when you return OK Question Title * 8. Would you describe your dog as generally shy, nervous or afraid? Never In certain situations Often but not always All of the time OK Question Title * 9. Have you tried to help your dog with any of these behaviors? If so, how? No Yes, with a traditional trainer Yes, with a balanced trainer Yes, with a positive reinforcement trainer Yes, with a Behaviorist Other (please specify) OK Question Title * 10. Have you given your dog any medication to aid in reducing any unwanted behaviors? No Yes, with a daily medication Yes, with an “as needed” medication Yes, with CBD or other cannabis supplement Yes, with an over the counter supplement OK DONE