Behavior History FormBehavior History Form Help us develop the most effective plan for you and your dog by providing complete and thorough answers on this Behavior History form. There are no right or wrong answers.Name(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Name of Additional Contact(Required)Additional Contact Phone/Email(Required)DOG INFORMATIONDog's Name(Required)Gender:(Required) Male FemaleIs your dog spayed/neutered?(Required) Yes NoAge(Required)Weight(Required)Breed(Required)Have you done a DNA test?(Required) Yes NoWhen did the dog come to live with you?(Required)HOUSEHOLD INFORMATIONCheck all age groups represented by the people residing in, or spending a significant amount of time, in your household. Under 1 year 1 - 3 years 4-7 years 8-12 years 13-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80+ yearsWhat other types of animals are part of your family? (Check all that apply)(Required) Cat Bird Rabbit or Guinea Pig Mouse, Rat, Hamster, Gerbil Livestock (horses, cows, sheep, goats, pigs, chickens, etc.) Reptiles; Amphibians; Fish OtherMEDICAL & HEALTH INFORMATIONVeterinarian Contact Information:(Required) Clinic & Veterinarian Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Phone Date of your dog's last veterinary exam:(Required) MM slash DD slash YYYY Do you give Crimson Hound permission to discuss your dog's case with your veterinarian, if necessary?(Required) Yes NoProof of the following vaccinations is required: Rabies, Distemper, Hepatitis, Leptospirosis and Parvovirus (DHLP). Upload a copy of your dog's vaccination records here. If you are unable to do so, you can email a copy to training@crimsonhound.com or bring a copy to your FIRST training session. Drop files here or Select filesAccepted file types: jpg, png, pdf, Max. file size: 128 MB.Vaccination requirement is age specific. Puppies should be vaccinated as is age appropriate. Titer results are accepted.BEHAVIOR INFORMATIONList the behaviors that prompted you to contact Crimson Hound.(Required)Is anyone in your household afraid of this dog?(Required) Yes No Not sureAre you or another adult in the household able to physically control this dog?(Required) Yes No Not sureCheck all of the behaviors that describe your dog's reaction to each of the following scenarios: HANDLING/GROOMING:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsSTRANGE VISITORS:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsFAMILIAR VISITORS:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsFAMILIAR DOGS - YOUR HOME/YARD:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsSTRANGE DOGS - YOUR HOME/YARD:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsPEOPLE - OUT ON A WALK:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsDOGS - OUT ON A WALK:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsMOVING OBJECTS (cars, bikes, joggers ...):(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsNEW/UNFAMILIAR OBJECTS:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsVET VISITS:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsCHILDREN:(Required) Relaxed, loose body Turns away; Licks lips; Pants; Yawns Crouches; Hides; Pulls away Growls Barks/Lunges Bites; NipsIs your dog "protective" of any of the following:(Required) Food/Treats Toys Space (e.g., couch, bed, room) Particular people No known issuesSelect AllHow does your dog behave when you are preparing to leave the home?(Required) No reaction Paces Whines/barks Pants/drowlsSelect AllCheck any behaviors that your dog does when left alone:(Required) Relaxed (sleeps; chews appropriately; etc.) Whines/Barks/Howls Paces or moves from room to room Pants/Drools Urinates/Defecates Destroys household items (toys, shoes, etc.) Destroys doors, window sills, walls, etc.Select AllHas your dog snapped or lunged at or nipped/bitten a person? Describe each incident in detail - including how much damage was inflicted (e.g., no skin contact, scratch, stitches, etc.):(Required)Fights with dogs inside or outside your household: Describe each incident in detail - including how much damage was inflicted (e.g., no damage, scratches, stitches, etc.):(Required)Use this space to elaborate on any questions above or to add anything else that you would like me to know.May I add your name to the Crimson Hound mailing list to receive training tips, new classes and workshop offerings?(Required) Yes NoHow did you find Crimson Hound dog training?(Required)NameThis field is for validation purposes and should be left unchanged.Δ