Your Dog's Name *
Email *
Phone *
Your vet (if we are not your primary vet):
What is your main concern that you would like help and advice for? *
What prompted your visit? *
How has this concern affected you and/or your family? *
Are there other behaviour problems or changes your pet has shown? *
How frequently does the behaviour of concern happen (eg times per day/week) *
When did you first notice this concern and how has it changed over time? (eg the frequency, duration, intensity, the behaviours themselves) *
Please describe the last 3 episodes of the behaviour of concern and please include any details you can about the context (who, what, where, when?) *
Are there any other episodes prior to these which you feel are significant or memorable? *
Can you think of anything that may have been a trigger for the behaviour initially? *
Can you predict when the behaviour will occur now? *
How long does it take for you dog to return to their usual selves after displaying this behaviour? *
What do you do when your dog is showing this behaviour? *
What are your goals for treatment? *
Have there been previous attempts to manage this problem? If yes, please describe: *
Has any treatment method improved or aggravated the situation? *
Do you have any concerns around seeking a behaviour consultation for your pet? *
Have you considered removing your dog from the home if the behaviour doesn’t change? *
Breed *
DOB/Age *
Gender *
Desexed? At what age? *
Where did your pet come from? *
Why did you want a dog? *
How old was your pet when you got them? *
Why did you choose your dog's breed or type/size of dog? *
Why did you choose your particular dog? *
What was your dog like as a puppy - eg happy, shy, boisterous? *
Did you meet your dog's parents or see what environment they were raised in? If so, please describe what you know *
Has your pet had other owners? If your pet has been rehomed, do you know any details around this? (Why, when) *
Please list all family members, including age for children. If you have children in the house or who often visit, how old are they? *
Do you have other pets? (please describe species, age, breed, gender) *
How does your dog interact with other pets (eg friendly, avoid, plays, attacks) *
What type of home do you live in (eg apartment, property, house with big/small yard) *
Have you moved whilst having your pet? If so, how often, and how did they cope? *
Does your pet have any known medical problems? If so, please describe *
Has your pet had any illness in the past? If so, please describe *
Is your pet on any medication or supplements currently? *
Has your pet been on any medications for behaviour? If so please mention medication name, dose if known, their response, how long for, any side effects? *
Please describe your dog's daily schedule *
What percentage of the day is your dog Inside and Outside *
Does your dog stay home alone when you go out? *
How does your dog behave when they are home alone? *
How does your dog behave when you leave and when you get home? *
Where does your dog go when you have visitors? *
Where does your dog sleep?
What rough percentage of time per day does your dog spend sleeping or resting?
Diet: What does your dog eat? When does your dog eat? Where does your dog eat?
Can you remove food/bones/toys from your dog? (do not try if you are unsure)
Please list your dogs favourite foods or treats with most favourite first:
Visitors *
Strangers *
Children *
Familiar dogs *
Unfamiliar dogs *
Other animals *
Vet *
Groomer *
Loud noises *
Car travel *
Change *
Any other relevant things they react to? *
How long does it take your dog to settle down once he/she has reacted to something? *
What training have your done with your pet (eg puppy preschool, obedience training at home or at an organised group, clicker training, agility etc) *
How does your dog react to training classes? *
Does you dog know any tricks, if so please list *
