Reactive Dog Class Questionnaire

If you feel your dog should be in the Reactive Dog class, please fill out and submit the questionnaire.

Your Name(*)
Please let us know your name.

Your Email(*)
Please let us know your email address.

Dog's Name(*)
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Dog's Breed(*)
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Dog's Age(*)
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Dog's Sex(*)
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Neutered / Spayed(*)
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Phone Number(*)
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How long have you owned the dog?(*)
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Please check off all the stimuli that your dog is reactive to:(*)

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At what distance does your dog react to stimuli?(*)
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How far away does the stimulus have to be before your dog relaxes?(*)
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My dog is reactive or aggressive when: (Check all that apply)(*)

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Other/Comments
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This is how my dog shows reactivity or aggression: (Check all that apply)(*)

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Other/Comments
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I have used the following to correct the problem: (Please check all you've tried whether they have worked or not) (*)

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Other/Comments
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Has your dog ever bitten another dog?(*)
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If so, please describe.
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Has your dog ever bitten a person, including yourself?(*)
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If so, please describe.
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My dog is most reactive/aggressive when

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Does your dog play with other dogs? If yes, where?
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Has your dog ever been in a fight?
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What do you hope to achieve from this class and what is the behavior problem you want to correct the most?
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Date
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Type the characters you see in this box.(*)
Type the characters you see in this box.
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