Behaviour Questionnaire
Date
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Day
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Month
Year
Client Details
Owner’s name:
Pet’s name:
Pet’s breed:
Pet’s age:
Client phone number:
Client email:
example@example.com
Veterinarian:
Questions
How did you acquire the dog/cat? (From a breeder, shelter etc...)
How long have you owned the dog/cat?
What age was the dog/cat when it came into your care?
Does the dog/cat have any underlying medical conditions?
Last medical examination:
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Month
-
Day
Year
Is the dog/cat currently receiving medication for anxiety?
Yes
No
Has the dog/cat ever bitten a child or adult? (If so, please specify the extent of the damage i.e. puncture wound, no marking)
Did the dog/cat have a lot of interaction with people and other dogs/cats as a puppy/kitten?
What is the purpose of the behavioural consultation? (If the reason for consultation is problematic behaviour, please describe in detail i.e How the behaviour developed, when it was first noticed and when is it most likely to occur).
What would you like to achieve as a result of the consultation? (Please include the desired outcome, goals and aims, so that we can tailor our consultations process to suit your needs).
Submit
Should be Empty: