Canine Training and Behaviour Consult Form

Canine Training and Behaviour History Form

Name

Address

Street Address

Street Address Line 2

CityCounty

Post code

Email

example@example.com

Phone Number

REGULAR VETERINARIAN

Clinic

Veterinarian

Address

Street Address

Street Address Line 2

CityCounty

Post code

Phone

Country CodeArea CodePhone Number

Email

example@example.com

How did you hear about Carry on Canine?

Name

Breed

Date of Birth

Date

Weight

Age

Sex (please mark)

MaleFemaleI have both female and male dogs, please state dogs

Are they spayed or neutered?

What was the reason for desexing/not desexing?

Does your dog have any medical conditions? If yes, please explain.

Is your dog currently on any medications? If yes, please explain.

How old was your dog when you acquired it?

Where did you get your dog from?

Has your dog had previous owners? If yes, please explain

Why did you decide to get a dog?

Do you have any information about relatives of your dog?

Why did you choose this breed or crossbreed or type of dog?

Have you owned dogs before?

YesNo

What happened to them?

What are the 3 main issues you experience with your pet in order of priority

1

2

3

What is the problem that has made you call me?

How would you describe the severity of the problem? Mild Moderate Severe

How would you describe the frequency of the problem? Rare Often Frequently

Any noticeable change in severity?

Any noticeable change in frequency?

When did the problem begin?

Have you considered Euthanasia/Rehoming your dog?

How old was your dog when the problem begun?

In your own words describe the family dynamic in relationship to your dog/s

In your own words describe the relationship to your dog (s) and your other pets.

How often do you walk your dog and how long for?

What kind of formal training has your dog had?

Who trains your dog?

What have you tried in the past to help the problem behaviour?

What time(s) of the day do you feed your dog?

What do you feed your dog?

Describe your dog's eating habits?

How does your dog react when he see's unfamiliar people? Growls, Bites, avoids, humps, excited, jumps, friendly.

How does your dog react when he see's unfamiliar dogs? Growls, Bites, avoids, humps, excited, jumps, friendly.

Has your dog bitten?

How many times?

Has your dog broken skin with a bite?

How many times?

Is there anything else you think may be relevant to your dog that we may need to know?

YOUR INFORMATION

YOUR PET'S DETAILS

DESCRIBE YOUR FAMILY

OTHER PETS