E-mail

Phone

Address

Dog's Name

Breed

Age

Age of dog when obtained

Owner's previous experience with dogs

Briefly explain the reason for obtaning your dog

Briefly describe your ideal dog

Vaccination status

Date last dewormed

Is your pet currently on any medications or supplements?

If yes, please list name and dosage.

Has your pet been on medication for his/her behaviour in the past?

If yes, please list name and dosage.

Details of any medical contitions.

Details of other pets in household

Please specify names, species, ages, sex and whether they are spayed or neutered.

Details of people in household

Please describe Name, Age, Relationship with your dog

Please explain details of early life if known (including litter size, early illness, rehoming etc)

How was your dog housetrained? Please include details of the age at which you started training, and how long it took to housetrain your dog?

How did you treat mishaps at this time?

Have you ever attended training classes with your dog?

Please give details (when, where, age of pet, what was done)

Is your dog more obedient in different places or with specific individuals?

Do you play with your dog?

Please describe type of game. i.e. fetch, tug of war. How often do you play?

How do you correct your dog when s/he misbehaves?

How do you reward you dog when s/he has done well?

How would you describe your dog’s personality?

When faced with a new situation how is your dog likely to react if on the lead?

Does the behaviour change if on a lead as opposed to being free?

Does your dog have any known fears or things it dislikes?

What is your dog's diet?

Please give details of mealtimes/treats.

What sort of exercise (on lead/off lead/access to other dogs/play-time/other highlights does the dog get ona adaily basis and how often (i.e. details of daily routine)

Do you train your dog at home (if so, how)?

Details of the inappropriate behaviour.

When was it first noticed?

Has your dog ever shown aggressive behaviour (growling, snarling, snapping or biting) to any member of the household? If so, please give details

Does your dog treat all members of the household in the same? Please give details of any differences.

How does your pet react when visitors come to the house? (barking, door charging, etc)

Is there any sort of aggression in the following circumstances? (growling, snarling (showing teeth), lunging, nipping, biting).

When handling/grooming If disturbed when resting If disciplined When walking on lead If trying to take food away When petting or hugging If taking any other objects from him/her

Does your dog ever show aggression when examined by the vet?

Does your pet ever show inappropriate mounting or other sexual activity?

The Current Problem

When did it begin?

How long has it been present?

Where does it occur?

With whom?

How frequently does the problem occur?

i.e. times per day, per week, per month or per year

Please describe the first incidence of the behaviour that you can recall, the most recent and one other which you remember, i.e. 3 incidents in total.

What has been done to correct the problem?

Please indicate whether each measure has helped, made no difference or made matters worse

Do you suspect any cause?

Other details of the main complaint.

Any other behavioural problems?

What are the feelings of each family member about your pet’s present behaviour?

In an ideal world what would you hope to achieve with your dog?

What are the essential changes you need to be able to continue to live with your dog?

Please give any other information you think relevant to the case.