Email *
Phone *
Name *
Age *
Breed *
Does your dog have any medical conditions? *
Is your dog on any medications? *
Where did you get your dog? *
How old was your dog when you got them? *
What was your dog's behavior like as a puppy? *
Did you have any issues with toilet training? *
How many people live at home? *
Are there other people who regularly visit the home? (e.g: Dog walkers, Groomers, extended family members) *
How many animals live at home? What type of animals are they? *
What is your dog's relationship like with other animals in the home? *
How would you describe your relationship with your dog? *
Do you have any ailments that influence your ability to interact with your dog? *
What type of area do you live in? (ie: City/Town/Suburbs/Rural) *
What is the main behavioural problem or issue? *
What about this problem would you like to change? *
How frequently do these problems occur? (daily/weekly/monthly) *
Describe how this problem started and how it has developed over time: *
When did you first notice the main problem: *
In what circumstances does your dog show these behaviours? *
Has this problem changed in frequency? *
Has this problem changed in intensity? *
Has this problem otherwise changed? *
Does your dog have any other problem behaviours? *
Did these secondary problems develop at the same time?
Most recent incident: *
Second to last incident: *
Where do you keep your dog when you have guests and why? *
How does your dog behave when you are leaving home? *
How does your dog behave when you return? *
Does your dog's level of excitement reflect your length of absence? i.e. are they more excited the longer you are gone? *
How does your dog react to thunderstorms? *
How does your dog react to fireworks? *
Does your dog react to other noises? If so, what noises? *
How does your dog behave with familiar visitors? *
How does your dog behave with unfamiliar visitors? *
If yes, who? *
If yes, please describe: *
If yes, when? *
What have you done to correct the problem so far? *
How successful have these measures been? *
How do you discipline your dog for this or any other problems? *
Do you feel that you may have contributed to the problem? *
What are your goals for treatment? *
Do you feel this is achievable? *
Was the training helpful?
Do you have a current dog trainer? *
If yes, what? *
If so please detail play *
If yes, please describe: *
Leash walks: *
Supervised off leash walks: *
Unsupervised free roaming: *
