Positively Dogs Behaviour Questionnaire

Thank you in advance for taking the time to complete this questionnaire.

The aim of the questionnaire is to gather as much information as possible for the behaviour concern you are experiencing with your dog. I understand that you might not know the full answers to the questions but please answer the questions as fully as you can for the time you have known your dog. You may also find that not every part of the questionnaire will be relevant to your dog's problem, so please do not worry about leaving those sections blank
Name
Age
Breed
Time in your home
Name

NameSurname
Address
Postcode
Phone
Email
example@example.com
Please let us know the names of all the members of your household.
Are any of these members under 12yrs old? Yes - Please let us know their name and age:
Do you have any other pets? Yes - Please let us know their name, species, and age:
The current problem behaviour(s): Please describe in a few words the behaviour(s) you want to discuss during the consultation in order of priority:
1.
2.
3.
How often does the problem behaviour happen?
How long ago did the behaviour start?
Can you describe the first time the behaviour happened?
Can you describe the last the behaviour happened?
Have you tried anything to help with your dog's behaviour? If so what?
1.
Did This Help?
2.
Didi This Help?
3.
Did This Help?
Has your dog ever shown any behaviours such as growling, snarling, showing teeth, nipping, lunging, snapping, biting?

Yes - Please continue to the next question

No - Please continue to Your Dogs Personality
Have they shown these behaviours to any of the following?

Members of your householdFamiliar dogsStrangersUnfamiliar dogsKnown people but not members of your householdVeterinary staffChildrenOther
When do they show these behaviours?

When being petted or strokedlf disturbed when resting or sleepingWhen the dog sees them/itWhen someone enters your houseWhen being groomedWhen on leadDuring playDuring feedingOther
If your dog has ever bitten any person or animal, please provide us with some more details of the event
How would you describe your dogs' personality in general?

Nervous/WorriedAnxiousCalm/Laid backShyFriendlyOver-the-top
Does your dog's personality change from indoors to outdoors?If Yes, please describe how you feel this differs
Does your dog have any fears or things they dislike?
Is your dog responsive to training?

YesNo
Do you train your dog with treats?

YesNo
Is your dog muzzled trained ?

YesNo
What are your dog's favourite treats?
1.
2.
What are your dog's favourite activities or toys?
1.
2.
Do you walk your dog? Yes - Please continue to the next question

No - Please continue to General health
How often do you walk your dog?
What areas do you walk your dog in?
Does your dog eat treats when outside?

YesYes/AlwaysNo
How does your dog travel in a car?

N/AWellNauseous/SickRestlessOther
If yes, please let us know the name
Is your dog on any medication currently?

YesNo
If yes, please let us know the name
Are there any health conditions you feel are affecting your dog's behaviour?

YesNo
If yes, please describe further
Are there any adaptations or considerations we need to be aware of in order to help you get the most from your consultation?
I confirm the following :

Information that I provide about me, my household, and my pets to be correct to the best of knowledge. Any information not disclosed or found to be inaccuaate could lead to a misdiagnosis of the required treatment or approach.
Print Name
Signed

Clear
Date

MonthDayYear
Date
Please ensure the relevant investment fee is paid in full using the following details:

Jenny Baxter

Lloyds Bank Account : 39816368

Sort Code : 30-84-20
Please return the completed form either by email: admin@positivelydogs.co.uk or by post to: Jenny Baxter, 22 Easton Square, Sherston, Malmesbury, SN16 OLX

Once the questionnaire, veterinary referral/medical history and payment are all received I will contact you to confirm receipt. At that point return to positivelydogs and select a convenient time and date for both the initial call and consultation visit.
Should be Empty: