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CASE STUDY SUBMISSION FORM
Cheryl Smith
C.S.I. - HERMITAGE
Crime Scene Investigation for Challenging Canines
October 4-5, 2003 • Hermitage, PA
If you are interested in submitting a case study of a dog with a behavior problem, please complete the form below. Cheryl Smith will review the cases and let us know which ones she will use about 1-2 weeks prior to the event. Please note, only a limited number of cases will be allowed and cases will be chosen based on the educational value for the attendees. If your dog is chosen as a case study, you must be able to confine your dog in a crate (for safety reasons) when not be using for demonstrations.


First Name:
Last Name:
City:
State:
Work Phone:
Home Phone:  
Email:
Dog's Name:
Dog's Sex:
Dog's Breed:
Dog's Birth Date:
Spayed/Neutered:
If yes, what age:
Where did you get your dog?:

Why did you choose this breed?:

Describe the dog's environment and what you know of the dog's parents and/or siblings:

Members of the family, adults:
Members of the family, children/age/sex:
Other animals in the household:
Describe the dog's weekly interaction with other people:

Describe the dog's weekly interaction with other animals:

Describe the type and duration of daily exercise your dog receives:

When you are away where is the dog?:

Describe dog's behavior before you leave and after you return:

When you are home, where is the dog?

How much and from whom does the dog require attention?

Where does the dog sleep?

Last visit to the veterinarian (reason/outcome):

Current medication:

Vaccinations received:

Diet (type, changes in the last 6 months:)

Describe dog's eating behavior:

What formal training has your dog received?:

Describe your dog's behavior during training (learns quickly, unable to focus, easily aroused by external stimulation, etc.)

List commands your dog understands and the situations it will respond to reliably.

Dog/Human Behavior (action): avoid growl bark lunge bite
Dog/Human Behavior (people): family strangers men women adolescents children toddlers
Other Dog/Human Behavior:

Dog/Dog Behavior (action): avoid growl bark lunge bite
Dog/Dog Behavior (other dogs): siblings friends strangers
Total # of fights:
# of fights without bites:
# of fights with bites:
# of bites with punctures:
# of bites requiring vet care:
Describe the situations where the behavior occured beginning with the first incident:





Thank you for taking the time to submit your case study.

Puppyworks
PO Box 954
Benicia, CA 94510
events@puppyworks.com