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* 1. Owner's Name:

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* 2. Dog's Name:

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* 3. Please submit a photo of your dog:

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* 4. Breed:

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* 5. Age:

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* 6. Sex:

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* 7. Which rescue organization referred us?

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* 8. How long have you owned them?

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* 9. Has your dog bitten another dog?

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* 10. If yes, what is the worst result that has occurred?

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* 11. Has your dog bitten a person?

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* 12. If yes, what is the worst result that has occurred?

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* 13. How long has the reactivity or aggression been going on?

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* 14. Does their reactivity behavior usually occur in conjunction with:

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* 15. What behaviors occur when your dog sees another dog while walking?

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* 16. Number of Dog friends?

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* 17. Warms up to a new dog:

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* 18. Prefers? (dogs)

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* 19. Prefers? (humans)

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* 20. Is the reactive behavior:

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* 21. Did any of the incidents have occurred protecting:

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* 22. Does the reactivity or aggression occur during play?

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* 23. Did the incidents include any of the following:

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* 24. Does it appear that your dog targets only particular types of dogs?

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* 25. Is the size of the human or dog a factor?

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* 26. How much training if any has your dog received?

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* 27. How much exercise does your dog currently get a day

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