Dog Behaviour Questionnaire

Owner(s) Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Main phone number and any alternative phone number*

Referring Vet's name, contact number and email address*

Vet Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I am currently working towards independent accreditation, in order to achieve this I may need to have another colleague present so that my progress can be monitored (all notes will be kept secured and private). Would you be happy, if required, for a colleague of mine to attend the initial consultation? Would you be happy for either myself or my colleague (if they are attending) to be in contact with your vet and provide them with a report? (you will also receive a copy)*

YesNo

Would you be comfortable with the audio of the consultation to be recorded? This recording will be kept secured and private and is to help ensure all valuable information from the consultation goes into the report.*

YesNo

How did you hear about me?*

Your dog's name, breed and age*

Where did you get this dog from and how old were they when you obtained them?*

Your dog's gender & neuter status. If they are neutered at what age was this done?*

Reason for neutering / not neutering. Any behavioural changes after neutering?

If your dog were a person, how would you describe their personality?*

Which of your dog's behaviours do you find most difficult?*

Briefly describe the problems you are having: (You do only need to be brief, we will go into detail on the day)*

Please list the people, including yourself, currently living in the household. (For each person, please write their first name, sex, and general age and relationship to you).*

Approximately how much does everyone interact with the dog?*

What other animals do you own? (Species, breed, age, sex, neutered/not)

Do any of these pets have any current medical or behavioural problems?

How does your dog get along with all members of your household (including pets)?

Have the members of your household changed since you acquired this dog? How?

What animals have you owned previously? If dogs please list the breeds

Why did you choose to obtain a dog? How many previous owners has the dog had?*

If applicable, where did the breeder keep the puppies and were they hand-raised?

Approximately how many litter-mates were there and what were they like?

If you met your dog's parents, what were they like?

Why did you choose this specific animal?*

Do you know if the parents or siblings had/have any medical or behavioural issues?

Was s/he re-homed from a rescue centre? Which one?

Why were they re-homed?

How did you introduce leaving them overnight?

What do you food your dog?*

Food / Water*


How many times a day do you feed your dog?
Who mostly feeds your dog?
How much does your dog drink each day?
Does your dog enjoy food, or are they fussy?
Is your dog ever given bones and/or chews?

Do you feed them any supplements, e.g. vitamins, herbal? What and how often?

Do you feed them tidbits? What and how often?

What does your dog do during household meals / when your other dog is eating?*

Is there any aggression around food?

Have you noticed a changes in appetite or toileting?*

Describe a typical day for your dog.*

What type of exercise does your dog have (e.g. indoors/outdoors, walks, games)?*

How long is this for per day/week?*

Does your dog tend to be alone, or with other dogs? How does your dog behave around other dogs?*

On walks, do you keep your dog on a lead, or allow her/him to run loose?*

What type of lead, collar and/or harness do you use? Who walks your dog mostly?*

Does your dog enjoy walks?*

YesNo

What is your dog’s favourite toy? How often do you play with your dog?*

Where do you keep your dogs toys? Does your dog have free access to them?*

Who initiates play? What games do you play?*

Does your pet ever wake you at night? If yes, how often and why?*

What percentage of time does you dog spend inside vs outside *

Where does your dog sleep overnight? Your dog’s favourite sleeping spot during the day?*

Which parts of your home does your dog have access to? Does your dog have access to an outdoor space (e.g. garden)?*

Where does your dog stay when you are out? Is your dog left regularly? *

How long do you leave you dog for at most?

Please describe your typical leaving routine including toys or other distractions you leave and there are any problems while you are gone.

Do you have arrangements for your dog for when you go on holiday? Any upcoming holidays? If so, please give details.

Have you attended training classes with your dog? How old was your dog when you started?

How long did you attend the class for? What form did the training take?

How often do you practice training with your dog? Do you consider your dog to be a quick learner?*

Did you make an active effort to socialize them as a pup? If so, how?

Does your dog... Sit? Walk to heel? Come when called? Drop objects when asked?

What other commands does your dog know? What is your dog’s favourite reward?

Is your dog more obedient in particular places or with particular people present?*

How do you correct your dog if they misbehaves? What kind of things does your dog need correction for?

Grooming*

	Yes	No
Does your dog enjoy being handled/petted all over, including ears and feet?
Does your dog mind being picked up?
Does your dog enjoy being groomed/bathed by everyone?
Do you need to sedate your dog when you go to the vet and/or for clipping nails?

How often is your dog groomed? What kind of brush is used?*

Does your dog have any current medical problems that you know about? Do you know of any previous medical problems?*

When was your last complete veterinary check-up? Is your dog on any current medication?*

Has your dog been placed on any medication for any behavioural problems previously? Has your dog had any laboratory tests?

Have you noticed any change in your dog’s senses?

When did the problem begin? How long has it been present? How old was the pet when it began?*

Where & with whom does it occur? How frequently does the problem occur?*

Please describe the first incidence of the behaviour that you can recall, the most recent and one other which you remember. First incident:*

Most recent incident:

Another incident:

How have you and/or other people tried to treat this behavioural problem so far?

What do you think caused the problem? Do you think the issue is improving or getting worse?

Other pertinent details:

Other

	Yes	No
Does your dog sometimes toilet in an inappropriate place?
Does your dog lick or chew themselves more than you would expect?
Does your dog ever display inappropriate mounting, or some other sexual activity?

Does your dog sometimes perform any of the following behaviours?

	Yes	No
Tail-chasing
Sucking
Star-gazing
Invisible fly snapping
Light-chasing
Staring
Some other repetitive activity

How does your dog react to the following situations?

	Reaction
Familiar dogs on property
Familiar dogs off property
Unfamiliar dogs on property
Unfamiliar dogs off property
Strangers outside on property
Strangers off property
Strangers arriving indoors
Children
Thunderstorms /fireworks
Other loud noises
Other Animals
Small Animals
Livestock
Busy areas
Moving vehicles / prams
Car rides

What would your desired outcome be?*

How much time do you feel able to commit to working with your dog to solve these problems?

How do your family and friends feel about the problem?

What would you envisage happening if the behaviour problem persists?*

Dog Behaviour Questionnaire

General Information

Information about your pet

Household

Early History

Diet

Daily Activities

Housing

Training History

Handling

Medical History

Current Behavioural Problem

Rehabilitation