Dog Behaviour Consultation Questionnaire

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Client's Name

Dog's Name

Client's Address

Breed

Suburb

P/Code

Date of Birth/Age

Home Phone

Sex:

Male
Female

Desexed?:

Yes
No

Mobile

Colour

Who referred you ?

Vet clinic

Preferred Vet?

About Your Dog

Why did you decide to get a dog?

Where did you get your dog?

How old was your dog when you acquired him/her?

How long have you had him/her?

Number of littermates (if known)?

Why did you choose this particular breed?

Does your dog have any diagnosed medical conditions or allergies?

Please describe – include doses of medication

Is your dog currently on medication?

What for?

Was there a temperament test done on this dog before you acquired him/her? If yes, what were the results?

Did you meet your dog’s parents? If yes, briefly describe their behaviour:

Please describe your dog’s behaviour as a puppy:

How would you describe your dog’s behaviour as an adult?

Has this dog had any other owners? If yes, how many?

Why was the dog given up?

Have you owned pets before?

What happened to your last dog?

What basic obedience training has your dog had?

Private Trainer? If yes, their name:

Training club? If yes, which club?

How old was the dog when you started training?

Why did you take the dog to training?

Who in the family is the primary Trainer?

How did your dog behave at training?

What sort of training equipment do you use ?

Does your dog know any tricks?

How do you reward your dog for good behaviour?

How do you punish your dog for bad behaviour?

Who punishes the dog in this instance?

Has your dog ever worn a citronella or electric collar?

Has your dog ever growled at, lunged at or bitten another dog? If yes, please describe in detail:

Has your dog every growled at, lunged at or bitten a person? If yes, please describe in detail:

What do you feed your dog?

How often?

Home environment

Please list the people who live in your household:

Please list the ages of children who live in or visit your household:

Please list all animals living in the household:

What is your dog’s relationship to the other animals? Are they friendly? Hostile?

Have you moved since acquiring your dog? If yes, how many times?

Has your household changed in regards to people or other animals since acquiring your dog?

Daily Schedule

Do you play with your dog?

What is his/her favourite game?

What is his/her favourite toy?

Please allocate time values to each of the following:

On lead walks

Off lead walks

Unsupervised time loose in backyard

Playing indoors

Playing outdoors

Playing with you

Playing with other dogs

Total time of aerobic exercise per day?

What percentage of time does your dog spend indoors and outdoors per day?

Is your dog house-trained?

How did you house-train your dog?

Does your dog ever eliminate in the house? If yes, where, when, and urine or faeces?

Where in your property is the dog when you go out?

How does your dog behave when you are leaving the house?

When you return?

How does your dog behave with familiar visitors?

Unfamiliar visitors?

Do you have to restrain your dog when guests arrive (e.g. by the collar)?

Presenting problems

The main problem or complaint is:

Additional problems include?

How old was your dog when you first noticed the main problem occurring?

Has the intensity or frequency of this problem increased?

Has this problem changed in any other way?

What have you done to correct this problem so far?

How do you discipline your dog for this and other misbehaviour?

Anything you would like to add?

Which one of these statements applies to you

I would like to change the problem but it is not concerning me greatly The problem is serious and I would like to change it, but if it remains unchanged that’s OK The problem is very serious and I would like to change it however if it remains I will keep my dog and manage his/her behaviour to the best of my ability The problem is very serious and I would like to change it. If it remains unchanged I will rehome my dog or have him/her put to sleep