Dog Behaviour Questionnaire

Dog Behaviour Questionnaire

Thank you for filing out the questionnaire below in advance of your appointment. If you have two pets, you can complete all the details on one form, just note which pet you are talking about with each response.
Consultation date

MonthDayYear
Date
Your name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email address
example@example.com
Pet's name
Age of your pet
Breed (if known)
Weight (approximate is fine)
Occupation of owner(s)
Names of other household members,and their relationship to you (please include ages of any kids)
Who were you referred by, or how did you hear about Canberra Behaviour Vet?
Where did your dog come from (breeder, rescue, pet shop etc.)
How old was your pet when you got them?
Which vet do you go to and would your dog be under a different surname?
What attracted you to this particular pet or breed?
Other household pets (and ages)
Current problems with your pet (listed in order of importance)
What have you tried to fix the problem (it is okay to say nothing, there are no judgments here!)
Does your pet have a history of any medical problems or injuries?
Are you using any supplements, gadgets or natural remedies such as Adaptil, a Thundershirt, Citronella collar or Zylkene?
How do you feel about medications for your pet?
Describe an average day for your pet (including mealtimes, wake-up times and other routines)
What does your dog do when meeting new dogs?
What does your dog do when meeting strangers?
What does your dog do when meeting children?
Does your dog show fear of certain noises? eg. thunder, fireworks, kitchen noises.
How does your dog behave in the car?
How does your dog behave at the vet?
Have you done puppy school, any organised training or worked with a trainer? If so where/who?
Does your dog like to chew? If so, what (bones, toys, Kongs etc.)
Does your dog have any food sensitivities or allergies?
What do you feed your dog (include brands of foods you use)?
What is your dog's favourite treat?
Does your dog have his own bed or place in the house or outside that he likes to spend time, if so where? eg crate, dog bed inside.
Is your dog play or food motivated?
Does your dog lick his/her feet?
Has your dog had blood tests at any stage, if so through which vet clinic?
Does your pet experience frequent stomach upsets such as vomiting or diarrhoea?
Have there been any recent household changes that may have impacted your pet?
For additional resources, please tick any options you might enjoy.
I sometimes use an AI note-taking app to record consultations so I don't need to focus on writing notes. All information is stored confidentially. Are you happy for me to record our consultation?
Would you be happy for me to take a photo of your pet for social media and write an educational post that may help other pet owners?
Should be Empty: