GreenTree Animal Hospital

Canine Aggression Form

Thank you for choosing us! Please fill out the following form before your scheduled appointment.

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Canine Aggression Form

Please note: All * fields are required. If you have any questions, please call us at 847-680-6543.

General History

Length of Ownership: Please describe how and where you acquired your pet. Make sure you address the following items

  • How long have you had your pet and when and where did you acquire him/her?
  • If you acquired him/her from an animal shelter or rescue organization do you know why she was surrendered to the organization?
  • Why did you get your pet?

Reproductive History: Please describe your pet’s reproductive status. Make sure you address the following questions. Is your pet neutered?

  • If so, at what age and what was your reason for neutering.
  • Did you notice any behavior changes at the time of neuter?
  • If not neutered do you plan on showing or competing with your pet and then breeding?
  • Has your pet ever been bred?

Diet: Please describe your pets eating habits

  • What type and brand of food does your pet regularly eat?
  • How often and how much do you feed and how much of it does he/she eat?
  • Does he/she eat it all right away?
  • Where is he/she fed and by whom?
  • Does he/she get table scraps, treats, or supplements more than 2x a week? If so, how often and what?

Basic Medical Status

History of Medical Problems: Please describe your pet’s health and medical status. Make sure you address the following questions.

  • Does your pet have any known medical problems or past surgeries?
  • Is he currently being treated for medical problems?
  • Has your veterinary performed a medical workup for the behavioral problem? (please describe)
(Name, breed, sex, age obtained, current age, problems with the patient)
(Name, sex, age range, relationship, occupation)


Describe the type and amount of exercise your pet gets on a daily basis. Please address the following questions.

  • How frequently and how long are his walks?
  • Does he play fetch or with toys on walks or at home? (how long?)
  • Describe any other exercise.

Daily Routine

Training/Socialization: Now describe your dog’s socialization, training, and overall obedience.

  • Has your dog has formal training or socialization classes? If so, when, where, who took him, and how did he/she do?
  • What will he/she do on command at home? What will he do when distracted, such as when visitors come over or when there’s some outside distraction.
  • Anything else we should know about his/her training and socialization?

Specific Aggression History Questions


Check the following behaviors during each activity and who they exhibit it towards. Family refers to anyone the dog lives with.

Behavior at the Vet Hospital, Groomers, or With Unfamiliar People

Chase Behavior

Territorial Behavior

Bite or Snap History

  • Level One - Snap and miss
  • Level Two - Single bite with enough pressure to bruise or scrape
  • Level Three - Single bite that leaves punctures or tears from the canine teeth
  • Level Four - Single bite where the dog holds on and shakes or Multiple bites where the dog releases and grabs again
  • Level Five - Level four bite plus mutilation (body parts missing)
  • Level Six - Death

Please list the number of bites and level of bite below.

History and Progression of Bite or Other Aggressive Incidents

Describe the situation in detail and provide date/relative date of incident