PART ONE: GENERAL INFORMATION
YOUR DOG'S DETAILS Sex Desexed?
HOUSEHOLD INFORMATION
Sex Desexed Does this pet have any problems with the dog we will be seeing?
Sex Desexed Does this pet have any problems with the dog we will be seeing?
Sex Desexed Does this pet have any problems with the dog we will be seeing?
Sex Desexed Does this pet have any problems with the dog we will be seeing?
Sex Desexed Does this pet have any problems with the dog we will be seeing?
Sex Desexed Does this pet have any problems with the dog we will be seeing?
Where did you obtain your dog? If your dog had a previous owner, describe the type of household it came from and the reason(s) they gave this dog up.
What is the primary purpose of owning your dog?
DAILY ROUTINE Where is your dog when you are home? Where does your dog stay when you are NOT home? Where does your dog sleep at night? Where does your dog stay when guests visit
TRAINING AND SOCIALISATION HISTORY Do you walk your dog on a Have you ever used a crate to confine your dog? Has your dog attended any puppy or training classes? What type of training? Rate your dog’s performance at training Which of the following commands does your dog know? Does your dog follow commands at home? Does your dog follow commands when there are distractions, e.g., visitors, or activity outside? Describe the training techniques that you have used in the past. What techniques do you currently use?
MEDICAL HISTORY When was your dog’s last veterinary health check? When was your dog’s last veterinary health check? Does your dog have any medical problems? Please give details.
Does your dog have any medical problems? Please give details.
DIET How often do you feed your dog? Does your dog get table scraps, treats or supplements? Do you give a command (e.g. ‘sit’) before giving treats etc?
GENERAL BEHAVIOURS Excessive whining or barking Destructive behaviour (other than to toys) House-soiling Digging Pacing or repetitive behaviours like circling, chasing tail etc Excessive licking or nibbling at itself Does your dog have the same personality now, compared to when he/she was a pup? If ‘no’, describe how your dog differed as a pup.
Please give details of the dog’s parents and/or littermates behaviour, if known.
PART TWO: DESCRIPTION OF BEHAVIOURAL PROBLEMS In one or two sentences describe the PRIMARY reason you’re bringing your dog for a behaviour consultation.
What prompted you to start this process and organise a behavioural consultation for your dog?
PRIMARY BEHAVIOUR PROBLEM What percentage of the time does the behaviour occur, when the dog is in a situation where it could occur? How often does the behaviour occur? Over recent times has the problem changed in severity? Has it changed in frequency? Has it changed in intensity?
What will you do if you cannot reach these goals? Does your dog show agression(Required)
SPECIFIC AGGRESSION HISTORY QUESTIONS Growls, snarls and/or barks only at people Growls, snarls and/or barks only at dogs Snaps and misses people Snaps and misses dogs Bites with enough pressure to bruise or scrape people Bites with enough pressure to bruise or scrape dogs Given a single bite that left a puncture or tear to a person Given a single bite that left a puncture or tear to a dog Held on and shaken, OR given multiple bites, releasing and grabbing again, to a person Held on and shaken, OR given multiple bites, releasing and grabbing again, to a dog Please indicate if your dog has caused major injury to people Please indicate if your dog has caused major injury to dogs Has legal action been taken against the owner as a result of bite(s)? Are you or family members afraid, or uncomfortable around your dog? Do you fear for your own, or your family’s safety?
Personality Profile – How does your dog respond in these situations? Unfamiliar people at door Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar people in home Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar people, on neutral territory, on leash Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar people, on neutral territory, off leash Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar people, on neutral territory, patting/stroking dog Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Bicycles, rollerblades etc Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Joggers Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Cars / trucks, on neutral territory, on leash Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar babies <6 mth Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar children 1-6 Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar children 7-11 Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar teenagers Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Veterinary Practice Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar dog in home Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar dog, on neutral territory, on leash Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Unfamiliar dog, on neutral territory, off leash Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Owner leaving Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Owner returning Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
People Walking by the food bowl Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Removal of food bowl Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Removal of high value items Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Someone reaching over the dogs head to pat/stroke Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
A pat/stroke anywhere on the dogs body Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Grooming Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Bathing Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Clipping nails Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Picking up dog Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Playing rough Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Put collar /leash on/off Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Restrain by collar Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Approach on bed Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Disturb whilst sleeping Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Verbal reprimand Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Physical reprimand Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Staring at dog Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Car rides Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Stranger approaching car Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Vacuum cleaner Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Broom Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Fireworks / loud noises Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know
Thunderstorms Happy Neutral Submissive Anxious Fearful Barks/growls Snaps/bites Hyperactive Offensive or defensive aggression Don’t know