Dog Reactivity Form

Name *

First Name

Last Name

Phone *

(###)

###

####

Your dog's sex *

Male

Female

What is your dog's reproductive status? *

Spayed/neutered

Intact

Which of the following behaviours has your dog displayed? *

Triggers are things in the environment that cause reactive behaviours (e.g people, dogs, children, bikes etc)

Freezing and Staring at Triggers

Growling at Triggers

Barking at Triggers

Lunging Towards Triggers

Air Snapping at Triggers

Biting Triggers

If any, what type of punishment have you attempted to reduce your dog's reactive behaviour? *

Please be honest, I am not here to judge you I am here to help you!

Shouting

Hitting

Pinning to the Floor

Short, sharp pulls on the lead in repetitive manner (leash pops)

Prong collar

E-collar

None of the above

Date

MM

DD

YYYY

Date

MM

DD

YYYY

Date

MM

DD

YYYY

If your dog has gone to bite or has bitten a person, what level of bite occurred?

This is using Dr Ian Dunbar's bite scale

Level 1 - Obnoxious or aggressive behaviour but no skin-contact by teeth.

Level 2 - Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and slight bleeding caused by forward or lateral movement of teeth against skin, but no vertical punctures.

Level 3 - One to four punctures from a single bite with no puncture deeper than half the length of the dog’s canine teeth. Maybe lacerations in a single direction, caused by victim pulling hand away, owner pulling dog away, or gravity (little dog jumps, bites and drops to floor).

Level 4 - One to four punctures from a single bite with at least one puncture deeper than half the length of the dog’s canine teeth. May also have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held on and shook its head from side to side).

Level 5 - Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in each

Level 6 - Victim dead

Please tick this box to confirm all the information shared is up to date and accurate , to best of your knowledge. *

Confirm

Agree to T&Cs *

Please tick here to confirm you have read and understood our terms and conditions and privacy policy.

Confirm