Canine Behavior History Form

Please answer the following questions below. Detailed information is critical for Dr. Rigterink to diagnose and recommend a treatment program. This form should be sent to Veterinary Behavior of Indiana at least 7 days prior to your appointment.
Behavior Problem
Dog's Background
Diet and Feeding
Daily Schedule
Medical History

Aggression Screen  

  • GR - growl
  • SL - snarl/bare teeth
  • SB - snap/bite
  • NR - no reaction
  • NA - not applicable

Place the above behavior codes next to each question:

Aggression Towards People (Please skip this section if aggression towards people is not the problem.)