Dog behaviour questionnaire

Dog behaviour questionnaire
If possible please include any differences of opinion between different family members. Don’t worry if there are things you cannot recall, just add as much detail as you can. Where fields are required but do not apply, please enter N/A or none.
About you and your family
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownState / Province

Post Code
Phone Number*

Phone Number
Alternative Phone Number

Phone Number
Email
example@example.com

Your household*

	Name	Age	Relationship with dog (e.g. feeds, walks, plays)
1
2
3
4
5

Your dog
Name*
Breed*
Date of birth or age*
Age when bought/adopted*
Source (e.g. breeder/rescue)*
Sex*
If neutered, age at neutering*
Did you notice any changes after neutering (please enter none if none seen)?*
Training/activity classes attended (please enter none if none seen):*
Cues known (e.g. sit, stay, come, beg)*
Is your pet more or less obedient with different members of the household and/or in different locations (e.g. will not sit for son)? Please give full details.*
Do they have favourite toys/games? Please briefly describe them here.*
If your dog were a person how would you describe their personality?*
About the problem
Please list, in order of importance, the main problem(s):*
When did you first notice the problem occurring/how long has it been going on (please describe for each issue)?*
Fully describe the first incident you remember for each issue (including who was where & any possible contributing factors):*
Fully describe the latest incident (including who was where & any possible contributing factors):*
Any other example incidents you would like to tell us about?*
Does the problem behaviour occur in a specific location or with a specific person/people?*
How frequently does the problem occur? Is it getting worse/better/staying the same?*
What are the feelings of EACH member of the household about the pet’s problem behaviour?*
Background information
Medications or supplements your pet is currently on:*
Medications or supplements your pet has been on previously for their behaviour:*
How does your dog know when they have done well?*
How do you correct your dog when they misbehave? When do you feel the need to do this?*
Does your dog have any known fears or things it dislikes including e.g. traffic, fireworks, household noises, gunshots etc.)?*
What is your dog’s daily routine? It may help to think of a specific day last week rather than ‘on average’. Please include an example working day and non-working day (if applicable).*

Other pets*

	Name & age	Species/breed	Relationship with dog
1
2
3
4
5

Diet
What type of food does your dog eat?*

WetDryRawOther
What brand(s)?
How often do you feed your dog?*
What other treats or chews etc. do you give your dog?*
Any known issues with diet or toileting (e.g. fussiness, wet poos):*
Allergies & dietary intolerances*

My dog has no known allergies or intolerancesMy dog has an allergy or intolerance (state which below)
Known allergies or dietary intolerances:
Relationship with other dogs & people
How does your dog react to dogs they know:*
For all the questions in this section please include whether the behaviour changes when your dog is off lead
How does your dog react to dogs they do not know:*
How does your dog react to people they know:*
How does your dog react to people they do not know:*
Has your dog ever shown aggressive or concerning behaviour to anyone (people or animals):*

How does your dog react to regular visitors (e.g. friends, family, delivery people)*

	Name	Purpose of visit	Dog's reaction
1
2
3
4
5

In an ideal world what are you hoping to achieve with your dog?*
What are the essential changes in your dog’s behaviour you would need to be able to live with them?*
Under what circumstances might you consider rehoming or euthanasia?*
Are there any other details you would like to include?
By dating and submitting this form, I confirm I have read, understood and agree to the Contract for Pet Behaviour Consultancy Services, available at https://www.animalsenses.co.uk/about-5*

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Dog behaviour questionnaire

About you and your family

Your dog

About the problem

Background information

Diet

Relationship with other dogs & people