Dog - Behaviour Questionnaire

Please answer the following questions as completely as possible. The completed questionnaire helps us to assess the environment, social interactions, and behaviour of your dog, and hence determine the possible causes(s), prognosis and specific treatment protocol for their problem(s).

Your Name:*

Your Phone Number:*

Email:*

Pets Name:*

Breed:*

Age:*

Weight:*

MaleFemale

YesNo

Why did you decide to get a dog?

How long have you had your dog?

Why did you choose your pet over others?

Describe your dog’s behaviour as a puppy:

Has your dog had any other owners? If yes, how many?

Have you owned any dogs or other pets before?

Who is your regular vet (Practice and name of attending Veterinarian)?

When was your pets last veterinary examination?

Does your pet have any underlying physical or mental health conditions that have been diagnosed by a veterinarian?

Are these conditions currently well managed? And are they receiving any medication? including herbal remedies such as St John’s Wort or Rescue Remedy. Also, please list dose, frequency, and response to the medication:

What age was your pet desexed? If they are not desexed, do you plan on breeding with them?

Were there any behavioural changes after your pet was desexed?

Who feeds the dog?

What do you feed (include brand name) and how much of each food)?

Mealtime AM

:HourMinutesAM/PM Option

Mealtime PM

:HourMinutesAM/PM Option

Does your dog eat the food all at once? If not, how long do you leave the food down?

What is your dog’s favorite food treat?

YesNo

What type of food scraps?

Do you feed them straight from the table?

How many people live in your home?

What ages are the people in your home?

Hours spent away from the home?

Please list the animals living in your household:

Please describe your dog’s relationship with other animals (friendly, aggressive, hostile, fearful etc):

How would you describe your relationship with your dog?

What type of home do you have? (apartment, house, farm, etc):

How much exercise does your dog get daily? Describe exercise (on lead walks, off lead walks, fetch, etc):

Is your dog an inside dog? (If yes, how much time is spent outside vs inside?):

Where does your dog sleep?

Is your dog house trained? Does he/she even urinate or defecate inside? If yes, where?

How does your dog behave around loud noises like thunderstorms and fireworks?

What kind of training has your dog had? (Puppy classes, home training, obedience classes etc):

What kind of energy levels does your dog have? (Excessive, high, average, low):

Does your dog do any of the following: bark excessively, jump on you and others, paw at you, mount other dogs, people, and objects? If yes, please specify which ones and when they occur:

What are the main problems you are seeking help and advice about?

Please describe other problems you would like to discuss with us. Please describe the behaviour in detail:

When did you first notice the problems and when did they become a serious concern?

Have these behaviours gotten better or worse over time? Please describe:

What have you done to try and correct the problem and was it helpful?

How do you respond to your dog when he/she performs undesirable behaviours?

What are your goals for the consultation?

Do you have anything else you would like to mention?

Your vetYour veterinary team (such as reception/nurses)Online (social media/research)Friend/family

Dog - Behaviour Questionnaire

Dogs Background

Medical History

Diet and Feeding

Home Environment

Daily Routine

Presenting Problems