Furry Friends Pet Assisted Therapy Services

Canine Aggression Screen

This is the web version of our canine aggression screen form. If you prefer, you may submit a paper copy of the form, available from our volunteer registration packet. This form should be completed prior to attending our animal behavior etiquette class with your dog.

Dog owners, please complete the following rating system to rate your dog's reaction to each of the given scenarios. Your answers on this form are confidential and are not meant to eliminate you or your dog from further visits. This form will be forwarded to and retained by Furry Friends' Behaviorist. The purpose of administering this screen is to gauge your dog's overall reactivity and help the Furry Friends' Animal Behaviorist to access what might be a future problem area that can be worked on together. Only dog owners need to complete this screen. There are no screens for other animal types.

NOTE: This form is for people and pet(s) registering to become volunteers or existing volunteers ONLY!

Canine Aggression Screen

Personal Info
One form per each dog

Possible Answers:

  • NR = No Negative Reaction
  • SL = Snarl/lift lip
  • BG = Bark, Growl (not alerting bark)
  • SB = Snap or Bite
  • NA = Not Applicable
1 Take dog's food dish with food
2 Take dog's empty food dish
3 Take dog's water dish
4 Take human food that falls on the floor
5 Take rawhide away from dog
6 Take real bone away from dog
7 Take biscuit away from dog
8 Take toy away from dog
9 Human approaches dog while eating
10 Dog approaches dog while eating
11 Cat approaches dog while eating
12 Human approaches dog while playing with toys
13 Dog approaches dog while playing with toys
14 Human approaches/disturbs dog while sleeping
15 Dog approaches/disturbs dog while sleeping
16 Step over dog
17 Push dog off bed/couch
18 Reach toward dog
19 Reach over head of dog
20 Put on leash
21 Human pushes on shoulders
22 Dog mounts or shoves
23 Human pushes on rump
24 Towel feet when wet
25 Bathe dog
26 Groom dog's head
27 Groom dog's body
28 Human stares at dog
29 Dog stares at dog
30 Take muzzle in hands and shake
31 Push dog over onto back
32 Stranger knocks on door
33 Stranger enters room
34 Dog in car at toll booth
35 Dog in car at gas station
36 Dog on leash approached by dog on street
37 Dog on leash approached by person on street
38 Dog in yard - person passes
39 Dog in yard - dog passes
40 Dog in vet's office
41 Dog in boarding kennel
42 Dog at groomer
43 Dog yelled at
44 Dog corrected with leash
45 Dog physically punished
46 Someone raises voice to client in presence of dog
47 Someone hugs/touches client in presence of dog
48 Squirrels, cats, small animals approach dog
49 Bicycles and/or skateboards nearby
50 Crying infant
51 Playing with 2 year old children
52 Playing with 5-7 year old children
53 Playing with 8-11 year old children
54 Playing with 12-16 year old children