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.

If you would prefer to download and fill out the form at home, please click here. Please then submit your completed form to

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.)

Please note: Your behavior history form was uploaded to the Veterinary Behavior of Indiana's email address once you get a confirmation page with a picture of a large dog.