New Client Registration-HISTORY Form

New Client Registration-HISTORY Form

Thank you for taking the time to complete this pre-appointment form prior to your pet's behaviour consultation. It is long, so please allow time (& save often!).
First, the practicalities:

Your booking will be confirmed on receipt of your full fee, and all requested information - including [this] detailed Registration–History form; videos (including a narrated home tour, in the case of cats [and/or dogs - on request, as is relevant to the case]); +/- Veterinary Referral (for all behaviour cases) - details for all of which you will find in your Booking Confirmation Email. Thanks!
Please make payment of your FULL fee directly (as detailed in your Booking Confirmation Email). Please pay by BACs: account name - Inspiring Pet Teaching; sort code - 090128; a/c no. - 58024255; ref - your pet's name + your surname.*

I agree to payment terms, & confirm that I have sent my FULL payment via BACs
I/We confirm that - in the case of behaviour cases (as opposed to training only) - I/we will arrange my veterinary referral directly [3].*

Yes. I have asked my vet to arrange my pet's referral, & have sent the link to the Referral Form to my practiceN/A. This has been assessed as a training/prevention case
Now, the detail:

This form is an important piece of the diagnostic process. It is collaborative, & provision of lots of detail helps me to best help you & your pet.
Your pet's name: *
Your full name:*
Your e-mail address:*
example@example.com
Your 'phone number(s), including area code:*
Your full address, including post code?*
(If I am coming to your home, is there anything specific that I need to know or that needs arranging re: finding your home or parking?)*
Write N/A if I am not coming to you
Your occupation?*
Your pet's species *

DogCat
Your pet's breed-type: *
Your pet's current age:*
Your pet's gender: *
Is your pet neutered (castrated or spayed)?*

YesNo
Why did you choose this breed type? *
Why did you choose this individual animal? *
The approximate date or age you acquired or adopted your pet at: *
Where was your pet acquired from? *
What history & details do you know of your pet’s life prior to adoption? (E.g. breeding/rearing environment, shelter/rescue, mother & siblings’ temperaments, types of human interactions, interactions with other animals, etc.?) *
Please be as detailed & descriptive as possible
Are there additional pets in your home?*

YesNo
Please provide details about additional pets (species, breed(s), sex/neutered, age, length of time known to your above-named pet, number or additional pets, whether indoor/outdoor):
What is your above-named pet’s relationship status with any other family pets?*

N/A - I have no other petsFriendly (approaches/interacts)Neutral (ignores)AvoidsUnfriendly/antagonisesAny changes in how they interact? (please describe in the "other" box below)
Regarding interactions with other pets in the home/KNOWN animals, please tell us about anything of note - special bonds, problematic relationships, fights, any recent changes, etc.: *
Please write N/A if you have no other pets
How many people normally live in the home? And what is the family/household structure? *
How many people care/are responsible for your pet? Names of the caregivers:*
Are there children in the home, &/or do children visit?*

YesNo
How many children (under 18) live in/regularly visit your home? What are their ages?*
Please write N/A if none
How does your above-named pet interact with KNOWN people?*

Friendly (approaches/interacts)Neutral (ignores)AvoidsUnfriendly/antagonisesAny changes in how they interact? (please describe in the "other" box below)
Regarding interactions with household/KNOWN humans, please tell us about anything of note - special bonds, problematic relationships, fights, any recent changes, etc.:*
In just a few words, how would you describe your pet's personality? *
How would you describe the current status of your/the family's relationship(s) with your pet? (e.g. is it good, are you bonded, angry, frustrated, etc.…?)*
Please share three things that you like about your pet & that you enjoy about your bond with this pet*
Your Vet’s name, & Vet Clinic name & location - including their email address: *
Is your pet fully vaccinated against infectious diseases? *
Is your pet routinely treated with veterinary-prescribed parasite prevention? Product name(s) & approx. date of last treatment? *
What is the approximate date of your pet's last vet visit? What was the reason for this vet visit? *
Did you discuss training/behaviour with your vet? *

YesNo
How does your pet behave at the veterinary clinic? Has this changed?*
Does your pet have any current, ongoing, or past health conditions?*

YesNo
Is your pet currently on veterinary-prescribed medication?*

YesNo
Is your pet currently on non-prescribed, over-the-counter, complimentary or supplemental products?*

YesNo
Please give details of any veterinary-prescribed medications, +/- non-prescribed products: *
Please write N/A if there are none
What is your pet’s current state of health?*
Have there been any recent changes to your pet's health or ability? *
Do you think your pet has pain, or reason to experience pain?*
Is your pet insured? Which company are they insured with?*
If your pet has health insurance, does this policy include cover for behavioural treatment?*

YesNoN/A - my pet is not covered by health insurance
Is your insured to cover for 3rd party/public liability? (NB: this is highly recommended for ALL dogs)*

YesNo
If your pet is a DOG, do they have any pending, current or prior legal or police proceedings or investigations, &/or are they subject to police/legal orders, &/or subject to any conditions under the Dangerous Dogs Act 1991? If so, please give details, dates, and conditions (and attach a copy of any orders, below):*
What type/brand of food do you feed your pet?*
How often do you feed your pet?*
Do you think your pet enjoys this food? (& what makes you think this?)*
Roughly, how long does it take for your pet to consume his/her food? *
What does your pet normally eat from:*

Hand feedActivity or puzzle toy(s)Food BowlSprinkles
What type of treats do you feed your pet? And for what reason/how often?*
Have your pet’s eating habits or feeding routines changed? (Have any changes been due to yours, or your pet's choices?) *
Does your pet have food any sensitivities? *
How much & what type of daily exercise does your pet get (For DOGS: this includes on/off property & self-directed +/-human-accompanied walks. For CATS: this includes 1. whether they are indoor/outdoor; 2. how much/what type of activity they do per 24/hours; & 3. when they are most/least active): *
What percentage of time do you estimate your pet spends INDOORS? During this time what are they doing?*
What percentage of time do you estimate your pet spends OUTDOORS? During this time what are they doing?*
How is your pet when at exercise?*

ActiveBusyFrenziedCalmReluctantWorriedExcited
Have your pet’s exercise habits or routines changed recently (when & how)? Who instigated any changes (you/your pet)?*
Briefly describe a typical day for your pet (e.g. exercise, feeding routine, time spent alone, training +/- play time, human interactions, other pet interactions, down time, etc.): *
In general, have your pet’s routines changed recently? When & how? Who instigated any changes (you/your pet)? *
Are you seeking help for a perceived training or behavioural problem (please see our FAQs for further details on how to know this)?*

Behaviour/remedial (e.g. emotional problems, veterinary referral, problem behaviour)Training/preventive (e.g. puppy or kitten socialisation, trouble-shooting, manners/life skills)I am unsure - I will provide further information below, so that Inspiring Pet Teaching can ascertain the nature of my query/concern, based on my responses
What particular concern(s) do you have about your pet's behaviour? **
Please be as descriptive as possible
Approximately, when did you first become aware of this problem? And how long has it been going on for? *
Please be as descriptive as possible
From the time you first noticed this problem (or your query began), how has it developed/changed? (Better? Worse? The same? Intermittent?) *
Please be as descriptive as possible
When does the behaviour in question occur? *
Please be as descriptive as possible
When does the behaviour in question NOT occur? *
Please be as descriptive as possible
How often does the behaviour in question occur? *
Please be as descriptive as possible
How long does the behaviour in question occur for? *
Please be as descriptive as possible
What starts the behaviour in question? *
Please be as descriptive as possible
What causes it to stop? *
Please be as descriptive as possible
Does anything make the behaviour in question WORSE? (Or better?) *
Please be as descriptive as possible
What have you already tried to solve this problem behaviour? (If there is more than one behaviour of concern, please least what you have tried for each) *
Please be as descriptive as possible
Of the things you have tried to deal with the behaviour in question, a) what has worked? & b) what has not worked? *
Please be as descriptive as possible
Regarding the behaviour(s) you have questions or concerns about, would you like to add any more descriptions, comments, or specific questions/discussion points for when we meet? *
Please be as descriptive as possible
Other than that described above, have there been any other recent changes to your pet’s behaviour? *
Please be as descriptive as possible
Please could you send a brief video of this problem(s), +/- your pet’s “normal” in problem situations, when you return this form, if possible - WeTransfer (use email address: linda@inspiringpets.com) or WhatsApp (use 'phone no.: 07985 905 183) is a good way to send video (NB: Please only do this if it is safe to do so, & doesn’t cause your pet distress - i.e. try to capture it as it happens, rather than set it up to occur). Maximum single video length: 90 seconds please. (Please let me know when they have been sent.)*

I will do this ASAP/this week
Please provide a simple/basic house plan/layout, marking all your pet’s resources: including water, food, sleeping/resting places, hiding places: locations of other pets; doorways & windows; +/- any areas the home/garden that problem behaviours occur. For CATS please mark locations of scratch poles, litter trays, cat flaps/home entry or exit points. NB: this can be done free-hand, digitally or transcribed onto a copy of your existing house plan/plot, & uploaded here - it does not have to be a “work of art”, or to scale! (Example included at the bottom of this form [1].) Feel free to also attach relevant & useful ‘photos of resources/your pet’s areas, +/- problem locations, if helpful (options to do this are included at the end of this form).*
Please upload PET-RELEVANT house plan
Please provide images of your pet’s resources: including water, food, sleeping/resting places, hiding place; locations of other pets (& their resources); access points, e.g., doorways & windows; +/- areas your pet can see/surveil from indoors; any areas the home/garden that problem behaviours occur. For CATS, visualisation of resources, & in context, is vital, e.g., scratch poles, litter trays, cat flaps/home entry or exit points. Feel free to also attach additional relevant & useful ‘photos of resources/your pet’s areas, +/- problem locations, if helpful (options to do this are included towards the end of this form).*
Please upload PET-RELEVANT house plan
Have you/the family or household HAD any recent/current life, routine +/- home changes (please give brief details)? *
Do you/the family PREDICT any upcoming life, routine +/- are any household or home changes predicted (please give brief details)? *
In general, how much time does your pet spend alone at home? (Average daily time alone? Average weekly time alone?) *
What is the longest time your pet is typically alone for? *
Please describe your pet’s reaction to being left alone: *
When alone, what do you think your pet is doing? (Have you ever filmed/recorded them? What did you see/hear?)*
How does your pet generally take food & treats from your hand: e.g., gently, snappy, etc. (Does this change in different situations? How?) Please describe: *
What happens if you take something away from your pet? Food, chews, toys, etc.? (NB: Please DON’T TRY THIS OUT to answer the question, just describe anything of note.)*
Does your pet ever steal, cache or guard items?*
How does your pet react to people who enter your home? *
In interactions with UNKNOWN people - inside & outside the home, how does your pet behave? (Please be as descriptive as possible):*

Friendly (approaches/interacts)Neutral (ignores)AvoidsUnfriendly/ antagonisesAny changes in how they interact? (please describe in the "other" box below)
Regarding any changes in behaviour towards unknown people, or anything else of note, or concern, please describe: *
How does your pet respond to people +/- animals approaching or passing the home?*
Do they spend time actively patrolling/surveiling? If so how much? Do they seem calm, alert, upset, other? *
In general, how does your pet respond to sound? (Please consider their reaction to noises within the home; outside; unexpected noises; loud noises) *
Please be as descriptive as possible
In general, how does your pet respond to new situations, +/- objects? Please describe:*
Please be as descriptive as possible
In general, how does your pet respond to movement (e.g. cars, bikes, joggers, objects)? Please describe: *
Please be as descriptive as possible
Does your pet react differently to certain types of people: e.g., toddlers, men, etc.?*
Please be as descriptive as possible
Has your pet ever bitten or injured anyone? If yes, describe in detail:*
Please be as descriptive as possible
If yes, please describe sustained injuries & medical care needed: *
Does your vet know about any bite/injury these human-directed incidents?*

YesNo
In interactions with other pets outside the home/UNKNOWN animals, how does your pet behave?*

Friendly (approaches/interacts)Neutral (ignores)AvoidsUnfriendly/antagonises
If your pet is DOG, how do they react to other pets on walks?*
Please be as descriptive as possible
Regarding any changes in behaviour towards UNKNOWN animals, or anything of note, or concern, please describe: *
Please be as descriptive as possible
Has your above-named pet ever bitten or injured another animal(s)? If yes, please describe: *
Please be as descriptive as possible
Has your above-named pet ever BEEN bitten or injured by another animal(s)? If yes, please describe: *
Does your vet know about any bite/injury these animal-directed incidents?*

YesNo
How does your pet typically respond to handling, e.g. for routine care, grooming, treatments, procedures, putting on of collars/leads/harnesses, human-instigated petting, being lifted up, etc.? Easy/difficult, scared, struggles - please describe in detail: *
Are there any situations which you actively avoid with your pet? Why? Please describe in detail: *
What specific goals would you like to focus on for training & behavioural management?*
Of the above goals, what are your top three training priorities (i.e. things you would like your pet TO do [as opposed to things you'd like to stop!])? *
Has your pet had a behaviour consultation before, +/- previously participated in private lessons or training classes? (How did it go?)*
If yes, please provide details of the training, trainer/behaviourist name, location & approx. dates: *
What methods were used (e.g. rewards, clicker, punishment, mixed, don’t know): *
What, if any, behaviours (e.g. tricks, obedience, sports, etc.) have you taught your pet? (What was your reason for teaching these behaviours?) *
Does your pet come when they are called? (Always, sometimes, never - when/when not?) Please describe: *
If your pet is DOG, what type of equipment does s/he wear, e.g. for exercising/training - flat collar, no-pull harness, other? (Why do you choose this equipment?) *
If your pet is DOG, what type of lead do you use: e.g., standard clip, retractable, slip, etc. (Why do you choose this equipment?)*
If your pet is a DOG, do they pull on the lead? (Always, sometimes, never - when/when not?) Please describe:*
Regarding previous or existing training/“obedience” - have there been any recent changes? Please describe:*
If you do any training with your pet, are they active, excited, frenzied, calm, reluctant, other? Please describe:*
What games do you play with your pet? (E.g. Fetch or catching objects? Tug? Chase Me? Wrestling & play-fighting? All/none of these? Other?) Please describe: *
What is your pet’s favourite activity or game? (What makes you think they enjoy this?)*
How often to you play with your pet? *
Who instigates play - you/your pet? (Both/neither?) *
Have there been any changes in how your pet plays? Please describe: *
When at play, is your pet active, excited, frenzied, calm, reluctant, other? (Do you have any questions or concerns regarding your pet's play?) Please describe: *
How does your pet show affection for human family members? *
How do human family members show affection towards your pet? *
In general, regarding human-pet interactions: typically, who approaches who? Typically, how long to interactions last? Who tends to end affectionate interactions? (You or your pet?) Does your pet welcome affection? Do you think they enjoy it? Tolerate it? Dislike it?*
In general, how do you think your pet responds to your emotional state? *
Is your pet crate trained? If yes, please describe how your pet responds to the crate: e.g., relaxed, reluctant, upset, etc.*
Is your pet house/toilet-trained (or litter trained)? Does your pet toilet in unwanted locations in the home? Please describe: *
Regarding toileting habits & routines, have there been any recent changes (e.g. frequency, consistency, effort/ability, other)? Please describe:*
How much sleep would you estimate your pet gets, per 24 hours?*
Where does your pet rest when you are home? Does your pet rest well there?*
Where does your pet stay when left alone: e.g., crate, a certain room, free run of house, etc. *
What is your pet’s normal night-time activity level (sleeping, restless, active, isolated, with you, etc.)? *
Have there been any changes to your pet’s sleep/rest patterns? *
What happens to your pet when you are away, e.g. on holiday? How do they respond to this arrangement? *
Are there any problems getting into, travelling, or being left alone in the car?*
Does your pet enjoy car travel? Do they seem anxious? Do they settle? Pace +/- pant? Vomit +/- toilet? Other comments/concerns related to travel/transport - please describe: *
How does your pet interact with wildlife +/- livestock, e.g. ignores, chases, kills, etc. (please be as descriptive as possible)? Do they hunt/show predatory behaviours? Have there been any changes? *
Do you give permission for Inspiring Pet Teaching’s trainer to feed your pet/give treats?*

YesNo
Is there any food you would prefer your pet not to have? *
Please give details
Is your pet currently fed raw meat or foodstuffs, either in part/occasionally or entirely/frequently)*

YesNo
If your pet has originated from outside the UK, have they been tested for diseases infectious to humans (e.g. brucellosis)?*

Yes, & all was negativeYes, & there was a positive result (please give details below)No, not testedN/A, my pet originated from within the UK
Please share any additional information you think we should know about you & your pet(s). Please also detail any questions or concerns which you would like to draw particular attention to, or to focus on when we meet:*
Is there anything you would like to share about your own physical abilities that would help Inspiring Pet Teaching to ensure your comfort or safety, & to optimise your success whilst training with your pet? Do you have any special requirements? (Please include details of any foodstuffs we may be using for training which anyone in the house is allergic to, e.g. peanut butter) *
Optional: Would you like to upload any additional images of your pet's areas, problematic home spaces, behaviours or interactions? In which case, please do so here. (Videos to be sent separately via WhatsApp or WeTransfer please)

Browse Files
Optional please upload any additional relevant images, notes or documentation Cancelof
Optional: Would you like to upload any additional images of your pet's areas, problematic home spaces, behaviours or interactions? In which case, please do so here. (Videos to be sent separately via WhatsApp or WeTransfer please)

Browse Files
Optional please upload any additional relevant images, notes or documentation Cancelof
Optional: Would you like to upload any additional images of your pet's areas, problematic home spaces, behaviours or interactions? In which case, please do so here. (Videos to be sent separately via WhatsApp or WeTransfer please)

Browse Files
Optional please upload any additional relevant images, notes or documentation Cancelof
Where did you find out/hear about Inspiring Pet Teaching? *
What factors influenced your choice of behaviourist/trainer? (e.g. qualifications/experience, recommendation, location, price, online presence [website/social media], services offered, other)?*
I/We acknowledge receipt and agree to the Booking Confirmation Email, Key Facts (Parts 1 & 2), Terms of Business, Pricing Structure-Policy, & Privacy Policy (link to info below, for your convenience) [2].*

Yes
All of the information that I/We have given & is contained within this New Client Registration-History Form is true & correct*

Yes
I/We confirm that I am/We are over 18 years old, & have authority to give consent for, & to undertake training +/- behavioural treatment with, this pet.*

Yes
I/We give my/our informed consent for referral, & for sharing of my/our clinical history + all case-related details with my/our referring vet practice (+/- any other involved/necessary parties, as discussed), & I give permission for my/our vet practice to share my pet’s clinical records, & for Inspiring Pet Teaching and my/our vet practice to communicate and share information to allow collaboration on this case, for the duration of the case being under Linda Ryan/Inspiring Pet Teaching’s care.*

Yes
1. Example of a basic house map: click here
2. Please refer to our Key Facts (Parts 1 & 2), Terms of Business, Pricing Structure-Policy & Privacy Policy, which must all be read, understood & agreed to so as to gain your informed consent from you, & to proceed with consultations, training or behaviour modification with Inspiring Pet Teaching. All information is available to view here.
3. For behaviour cases (as indicated by your vet or your Booking Confirmation Email, please download, fill in the top part of the Veterinary Referral Form, then take or send it to your vet to arrange your Veterinary Referral (which will include a vet check for health & well-being). Our Veterinary Referral Form can be found here.
This form & all of its content is intended for the recipient only. It is copyright 2020 Linda Ryan, trading as Inspiring Pet Teaching. Please do not reproduce of share any part of this form or its content. Thank you!
Should be Empty:

New Client Registration-HISTORY Form

First, the practicalities:

Now, the detail: