Riverview Behaviour Consult - Dog

So that we may learn more information about your pet, please complete the information below prior to your appointment. Should you have any questions, please give us a call at 506.387.4015
Owner(s)
Client Name*

First NameLast Name
Phone Number*
Emergency Contact*

First NameLast Name
Emergency Number*
Client Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about our behaviour services?*
Patient Information
Pet's Name*
Date of Birth*
Breed*
Colour*
Sex*
Current Weight?*
Spayed/Neutered?*
If yes, date of surgery

MonthDayYear
Date
Name and e-mail or phone number of your veterinarian:*
Does your pet have any health problems? (arthritis, epilepsy, urinary tract disease, etc.)*
Does your pet take medications or supplements? If yes, please specify.*
What is the main reason for this consultation?*
In your opinion, what is the severity of the problem?*
Have you considered euthanasia?*
When did you first notice the problem?*
How old was your pet when the problem started?*
Describe the first time the problem behaviour occurred?*
Under what circumstances does the unwanted behaviour occur?*
How often does the problem occur?*
What have you tried to correct the problem behaviour?*
Describe the last three episodes in which the problem behaviour occurred (provide dates)*
Are there any other problem behaviours? If yes, please specify:*
If your dog has bitten, did the bite break the skin?*
Has your dog ever growled at someone? If so, who?*
Was the aggression directed against family members? If yes, towards whom?*
Or towards strangers? Whom?*
Are there types of people that make your dog more aggressive? (men, delivery person, etc.)*
Is there an area where the dog is more aggressive? (in the house, behind the fence, in the car, etc) *
How do you react when your dog shows aggression?*
Are you the first owner of this pet?*
Is this your first dog?*
How old was your dog at adoption?*
How old was your dog at weaning?*
Where did you purchase the dog?*
Other? Specify. *
Was the dog kept*
Describe the facilities*
Did you see your pet's parents? If yes, describe their behaviours:*
Were there other puppies in the litter?*
Home Enviornment
How many people live in the home?*
How many adults?*
How many children?*
How many seniors?*
Are there any physically or mentally challenged persons?*
Name of the adults in the house:*
Name and ages of the children:*
How does the dog interact with members of the family?*
Are there any other pets in the home? Dogs, cats, other (specify). If yes, please provide the name and ages of the other pets:*
How does the dog interact with the other pets in the home?*
Where does your dog live?*
Describe the pet's environment (single family home, apartment, fence yard etc): *
How many hours a day is your dog home alone or outdoors alone?*
Feeding Behaviours
How is your pet's appetite?*
Does your pet eat:*
When your pet gets their meal, does he:*
Number of meals per day*
Does the dog eat*
Where does your pet eat?*
What does your pet eat? (brand and quantity)*
Do you give treats?*
What kind and what frequency?*
Under what circumstances do you give your pet treats?*
Name the treats and toys your dog likes in order of preference:*
Water Consumption
What quantity of water does your dog drink per day?*
Does your dog empty the dish every time or drinks and leaves some?*
Elimination Behaviour

If your pet urinates or defecates in unappropriated areas, fill in this section. If not, move onto the next section.
Housetraining
How long did it take you to housetrain your dog?*
Where was your dog housetrained? *
Have you ever used crate training?*
Are you still using the crate?*
If yes, when are you using the crate?*
If other, please specify:
What is his behaviour in the crate?*
Does your dog house soil?*
If yes, what does he do?*
Since when? *
Where? (Stools)*
Where? (Urine)*
What is your reaction when he house soils?*
How many bowel movements does your dog have per day?*
What is the texture of the stool? *
How many times does your dog urinate per day?*
Does your dog urinate lying down or in their sleep?*
Does your dog urinate when excited or when afraid?*
Other Behaviours
Does your dog lick his/her self?*
Does your dog bite or chew at the their skin?*
How does your pet exercise?*
How often and how long does your dog exercise?*
How do you play with your dog?*
What is the energy level of your pet?*
Does your pet solicit attention?*
Does your pet lick or mouth you excessively?*
Does your pet mount you?*
Does your dog push you with their body?*
Does your dog eat stools?*
Does your dog raid the garbage bin?*
Does your dog eat non-food items? If so, please specify:*
Does your dog have repetitive behaviours such as tail chasing, staring at nothing, snapping at imaginary flies, chasing shadows, other? Specify.*
Does your dog chase, hunt or kill other animals? Specify.*
Does your dog bark or howl excessively in your presence?*
When you are absent?*
Is your dog abnormally shy?*
Does your dog have any fears or phobias? Specify*
Sleeping Behaviours
How many hours per day does your dog sleep?*
Where does your dog sleep at night? *
Does your dog wake you up at night?*
Departure Behaviours
How does your pet behave when you leave them at home?*
How does your dog react before you leave?*
How does your dog react when you return?*
Training
Did your dog attend puppy preschool classes?*
How did your pet behave? *
Has your dog been to obedience classes? If yes, when?*
Have you taken obedience classes with another dog? If yes, when?*
How does your pet react to the following situations?

Note: please do not test your pet's reactions. Only if they have been in such situations.
When you pet him/her?*
When you hug him/her?*
When you pick him/her up?*
When you ask him/her to get off the furniture?*
When he/she is on the sofa and you sit down next to them?*
When you disturb him/her when they are sleeping?*
When you are near their food dish?*
When you touch their food bowl?*
When you give him/her table scraps?*
When you approach him/her when they have a toy?*
When you take a toy away?*
When you verbally correct him/her?*
When you physically punish him/her?*
When you stare him/her int he eyes?*
When you stand over him/her?*
When you reach for him/her?*
When a stranger reaches for him/her?*
When on lead?*
When holding him/her by the collar?*
When you put on a collar?*
When you give him/her a bath?*
When you brush him/her?*
At the groomers?*
When you clip him/her claws?*
When you correct him/her with a pinch or choke collar?*
When he/she goes to the veterinarian?*
When a stranger enters the yard or house?*
Reaction to children?*
Reaction to men?*
When a stranger approaches you?*
When he/she sees another dog while on lead?*
When he/she sees another dog from inside the house?*
With other small pets and cats?*
Reactions to bicycles and skateboards?*
Reaction to runners?*
Reaction while in the car?*
Reaction to thunderstorms?*
Reaction to other loud noises?*
Are there any other unusual reactions that your pet does that concern you?
Should be Empty:

Owner(s)

Patient Information

Home Enviornment

Feeding Behaviours

Water Consumption

Elimination Behaviour

Other Behaviours

Sleeping Behaviours

Departure Behaviours

Training

How does your pet react to the following situations?