Owner's Name
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First Name
Last Name
Address
Phone
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Email
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Patient Name
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Patient Age
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Patient Breed
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Neutered or spayed? At what age?
At what age did you bring the dog home?
How many pups were in the litter?
Why did you choose this pup in the litter?
If a rescue or re-home, what do you know about their history or past?
Did you take your dog to puppy school or any other training classes?
What sort of training methods do you use with your dog? e.g. Positive reward, correction, clicker.
Who in the family does the dog training?
Does your dog come when called?
What basic commands does your dog understand?
Does your dog protect food, toys, or beds?
Does your dog protect territory?
What brand/type of food to feed your dog?
What times of the day do you feed your dog?
Do you give any supplements?
Do you treat your dog and what treats do you use?
Is your dog a fussy eater or do they enjoy their food?
Has your dog had any injuries or ailments in the past?
Does your dog have any previous or current medical conditions?
Is your dog on medication?
Does your dog suffer from stiffness, lameness, arthritis, or hip dysplasia?
Does your dog have any skin conditions?
How often is your dog groomed?
Are there any areas of the body your dog does not want to be touched?
How often do you exercise your dog?
Does your dog walk off lead?
Does your dog socialise with other dogs?
Do you use a dog walker?
Where do you usually walk your dog?
How does your dog travel in the car?
Is your dog happy to travel in the car?
Do you play with your dog?
What are your dog’s favourite toys and games?
How does your dog interact with other dogs?
How does your dog react when a strange dog approaches?
How does your dog react to strangers?
How does your dog react to strange visitors in the home?
How does your dog react to familiar visitors
Does your dog jump up at people?
Does your dog paw or lick people?
Does your dog bark at people or dogs?
Does your dog mount people or dogs?
Is your dog toilet trained in the house?
Does your dog have any accidents in the house at night?
Does your dog have any accidents in the house when you are out?
Does your dog have any accidents in the house when you are at home?
Does your dog warn you when they need the toilet?
Do you remember how you toilet trained your dog?
How do you react when there are accidents?
Is your dog crate trained?
Where does your dog sleep in the house?
Approximately how long do they sleep at night?
Does your dog wake you in the night? Crying? Toilet?
How often is your dog left at home alone and for how long?
Where is your dog usually when you have visitors?
Is your dog comfortable left alone at home?
Does your dog destroy the home or furniture when you are out?
How does your dog react when you come home?
Does your dog chew or destroy furniture when you are home?
Do you provide chew toys or treats for your dog and how often?
What sort of house do you live in?
Have you moved house since you have had your dog?
How many people are in your family/live in the home? (name, age and sex).
Has anyone new moved into the house since you had your dog?
Does everyone interact with the dog?
Does your dog interact with everyone in the house?
Do you have any other animals?
Please describe the problem behaviour’s that you would like to improve in as much details as possible.
When did this behaviour appear to start?
When does your dog express this behaviour?
What immediately precedes the behaviour?
What happens immediately after the behaviour?
How do you respond to the behaviour?
What appears to stop the behaviour?
What measures have you taken to improve the behaviour so far?
Have you seen a behaviourist in the past?
How does this behaviour impact your life?
How frequently does the behaviour occur?
Has the problem changed in intensity?
Does it always occur in the same place?
Who is usually present when the problem occurs?
When was the last incident? Can you describe it as much as possible?
Do any related dogs have a similar problem?
Does your dog have any contact with dogs with similar problems?
If your dog is an entire bitch, could this be related to season?
What time are you able to commit to a training plan and working to solve the problem?
What is your ideal end scenario to achieve from this behaviour assessment?
What would you envisage happening if the behaviour persists
