Your Name (required)
Dogs Name (required)
Dog Breed (required)
Dog's Age (required)
Where did you get your dog?
What age was your dog when you brought it home?
If you acquired the dog as an adult, why were they re-homed?
HOME ENVIRONMENT
What type of Home? UnitTown HouseHouse with small yardHouse with large yardAcerage
Is the dog predominantly an inside or outside dog? InsideOutside
How many times a week is the dog exercised: Once a dayEvery 2nd dayTwice a weekOnce a weekOccasionallyNever
How long is each session 10mins10-45 mins45 mins - 1 hr1-2 hrs2+Hours
What toys does the dog have? Which is their favourite?
Where does the dog sleep at night? On their own bedIn a crateOn the floorOn furnitureAnywhereOutside KennelOutside on own bed
Is your dog happy to be left alone YesNo
How do they behave when left alone?
TRAINING & SOCIALISATION
What age was your dog when it began training?
Has your dog attended formal training? YesNo
If yes, what age was your dog when they started?
Who conducted the training program?
How confident is your dog? Very confidentConfidentShyFearful
Is your dog shy / fearful / over-excitable around any of the following: Loud NoisesPeopleChildrenFamiliar DogsUnfamiliar DogsAnimalsMachineryFast moving objectsCars
MEDICAL HISTORY
Does your dog have any pre-existing medical conditions? YesNo
Is your dog currently on any medication? YesNo
Is your dog currently vaccinated? YesNo
Do you use regular flea and worming treatment? YesNo
What do you currently feed your pet for main meals?
What do you currently feed your pet for Snacks?
BEHAVIOUR
Describe the problem behaviour in detail. (When it occurs, how long does it last, what do they do (jump, bark etc), is it directed at anyone?)
Is there anything that makes the problem worse?
How Frequently does the behavior occur? Multiple times a dayDailyWeeklyMonthlyOther
When was the most recent incident?
When was the first time your dog displayed this behaviour?
Has the frequency of the behaviour recently changed? IncreasedDecreased
Have you sought help for this problem previously? YesNo
If yes, what have you tried so far?
Your Email (required)
Anything else to add?
