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Bite History Questionnaire

To best serve your dog and your family, it helps me to have as much information as possible. There are no “wrong answers.” Please be honest in your responses. A bite history doesn’t mean I can’t help you, it just means we might have to adjust our training plan to keep everyone as safe as possible. In some cases, I will recommend working with a Veterinary Behaviorist.

Dog's Name

Your Email

Has your dog ever growled at a person? *

Never to my knowledge

Yes, once or twice

Yes, about 3 - 10 times

Yes, too many times to count

Has your dog ever air-snapped at a person (but no contact to skin)? *

Never to my knowledge

Yes, once or twice

Yes, about 3 - 10 times

Yes, too many times to count

Has your dog ever bitten a person but did not break skin? *

Never to my knowledge

Yes, once or twice

Yes, about 3 - 10 times

Yes, too many times to count

Has your dog ever bitten a person and broke skin, but the person did NOT require stitches? *

Never to my knowledge

Yes, once or twice

Yes, about 3 - 10 times

Yes, too many times to count

Has your dog ever bitten a person and broke skin, and the person DID require stitches? *

Never to my knowledge

Yes, once or twice

Yes, about 3 - 10 times

Yes, too many times to count

Has your dog ever bitten a dog who required veterinary care as a result? *

Never to my knowledge

Yes, once or twice

Yes, about 3 - 10 times

Yes, too many times to count

Age of the bite victim(s)

Did any of the incidents require medical attention?

No

Yes

During the incident(s), did the dog:

Make contact and release on his own?

Make contact, hold and shake, then release on his own?

Make multiple contacts, including shake or tear, then release on his own?

Make contact and did not release on his own?

What happened after the dog released or was made to release?

Went after the victim again

Ran away

Stayed away from victim

Other

Did the dog know the other person involved in the incident(s)?

No

Yes

Where did the incident(s) take place?

In Home

On leash

Fenced yard

Off leash outside of home/yard

Other

Did the dog approach the person?

Yes

No - the person approached the dog

Did the dog appear to be guarding something when the incident took place?

No

Yes - Food

Yes - Toys

Yes - Bedding or Furniture

Yes - Person

Other

If the incident took place outside of a fenced yard or house, how was the dog outside this area?

Escaped house

Escaped yard

Walking on leash

Walking off leash with owner

Thank you for providing this information!

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Lori Jacober, CPDT-KA

Certificate # 1217449

Premium Member APDT

Member PPG

PetTech Certified in CPR/First Aid

206-612-2547

lori@woofwaglove.com

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