Canine Behaviour Consultation Questionnaire

  • Canine Behaviour Consultation Questionnaire

  • Client Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Preferred Form Of Communication*
  • Preferred Time Of Appointment*

  • Regular DVM

  • Format: (000) 000-0000.

  • Pet Information

  • Date of Birth
     - -
  • Sex
  • Any behavioural changes after spay/neuter?
  • For what purpose did you obtain this pet?

  • The home environment

  • Do you have other pets in the home?

  • Daily Activities and Routines

  • Does your dog get physical exercise daily?
  • Does your dog get mental exercise (training, puzzle games, thinking games etc.) daily?
  • Have you ever used a crate for confinement?
  • Do you still use a crate?

  • Training

  • Obedience Training
  • Type of training
  • Which training was MOST effective?
  • Which training was LEAST effective
  • Rows
  • Rows
  • Does your dog know any additional tricks/ commands?
  • Can you get your dog to settle on command?
  • Rows
  • Did any punishment make the behaviour worse?
  • Has any punishment ever led to aggressive or threatening behaviour?
  • Does your dog respond differently to punishment form different family members?

  • Handling

  • Rows

  • Housetraining

  • Is your dog completely housetrained?
  • Does your dog ever eliminate outdoors?
  • Does your dog signal to eliminate?
  • Does your dog soil in the home by
  • Does your dog housesoil when family members are home?
  • Does your dog housesoil when you are watching?
  • Does your dog urine mark?
  • Rows
  • Do you ever confine your dog to a crate?
  • Does your dog ever eliminate in it's crate?

  • Departure Behaviour Screening

  • Does your dog display any undesirable behaviours when left alone?
  • When you go out is your dog
  • Does the behaviour differ depending on length of time or time of day left alone?
  • Does your dogs behaviour change depending on who is the last to leave?
  • Has your dog ever been left at a
  • Is your dog ever left alone outside?
  • Does your dog exhibit any undesirable behaviours when left alone outside?
  • If your dog ever left alone in the car?
  • Does your dog exhibit any undesirable behaviours when left alone in the car?
  • Does your dogs homecoming behaviour change depending on who is coming home?

  • Reactivity Screening

  • Rows

  • Aggression Screening

  • Does your dog display aggression?
  • What is the primary type of aggression? (Select all that apply)
  • What do you believe is the potential for injury?
  • Is the aggression serious enough that you will be unable to keep your dog if it is not improved?
  • Have you considered euthanasia of your dog due to aggression problems?
  • Do you believe that you are able to predict and avoid or prevent all situations in which aggression might arise?
  • Does your dog exhibit aggression towards a familiar person?
  • Rows
  • Does your dog show any aggression towards an unfamiliar person?
  • Rows
  • Does your dog show aggression during handling/grooming?
  • Rows
  • Rows
  • Does your dog show aggression towards other animals?
  • Rows
  • Does your dog show any aggression around food, treats or toys?
  • Rows

  • Miscellaneous

  • Rows

  • Reinforcement Assessment

  • Medical Screening

  • Has your dog been to a veterinarian for a physical examination in the past 12 months?
  • Has your dog had labwork (bloodwork, urinalysis, etc) in the past 12 months?
  • Appetite (Select all that apply)
  • Does your dog have arthritis or other painful conditions?
  • Have you noticed an deficits in your pets senses?
  • Does your pet drink or urinate excessively?
  • Stool Quality
  • Urine
  • Does your dog have any other medical problems?
  • Is your pet presently on any medication or supplements?
  • Should be Empty: