Animal Behavior Form

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Rate your level of experience of guardianship:
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PRINCIPAL COMPLAINT
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The severity is:
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How many times has the problem occurred
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The problem(s) occur:
When the animal is alone
In the presence of familiars
During the night
In the presence of strangers
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Have you considered euthanasia?
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Animal’s Diet:
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Describe feeding habits:
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Environment/Lifestyle
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Who is in-charge of animal (including daily schedule, sex, and age if under 18)?
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4.
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Does this animal live with other animals?

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Does this animal get along with other animals?
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Activity
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Training
Has this animal had any formal obedience training?
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The animal’s ability to learn is
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Punishment
Have any of the correction techniques been used. If so, rate their success.
Physical (hitting)
Success:
Noise (Shaker can/siren)
Success:
Ultrasonic (Petagree)
Success:
Water spray
Success:
Verbal/shouting
Success:
Time Out
Success:
E-Collar
Success:
Citronella collar
Success:
Other
Success:
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Please do not submit any Protected Health Information (PHI).

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