You & Your Dog
YOUR DETAILS:
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
YOUR DOG:
Dog's Name
*
Dog's Breed
*
Dog's Age
*
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Your Unique Dog
Your Dog's History
HEALTH
Does your dog have regular vet check-ups? If so how often?
When was your dog's last vet appointment?
-
Day
-
Month
Year
Date
Is your dog physically healthy according to your vet?
*
Yes
No
Physical Health
Please provide details of physical health
Are there any ongoing health issues?
*
Yes
No
Ongoing Health Issues
Please provide details of ongoing health issues.
Is your dog on any medication or regular treatments?
*
Yes
No
Medication
Please provide details of medication or regular treatments
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DIET
What type of food does your dog eat for meals?
How many meals does your dog eat each day?
Approximate portion size per meal?
Has your dog's diet changed recently?
*
Yes
No
Change to diet
Please describe the recent change to your dog's diet
Does your dog have any regular treats?
*
Yes
No
Regular treats
Please describe what treats your dog has on a regular basis
Does your dog have any food allergies?
*
Yes
No
Food allergies
Please describe any food allergies that your dog suffers from
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EXERCISE
How often is your dog walked and for how long?
Where is your dog walked?
What equipment is used on walks? (Collar and lead, harness, Halti, etc.)
Does your dog run off lead regularily?
Yes
No
Does your dog take part in any other exercise activities? (agility, flyball, etc.)
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GROOMING
How often is your dog handled / groomed and for how long?
At home, at the groomers or both? (Select all that apply)
At Home
Groomers
When was the last appointment?
-
Day
-
Month
Year
Date
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TRAINING
This area is very important, because it tells us about your dog’s prior learning experiences. It is vital that your responses are honest and provide as much detail as possible, as it will help us to better understand your dog as we move forward.
Has your dog ever received any form of training?
Yes
No
How often is your dog trained and for how long?
What type of training has been used? (eg. treat training, clicker training, punishment, etc.):
What has your dog learned so far?
Has anyone outside the been involved with your dog's training?
*
Yes
No
Please describe what was involved:
What training equipment is used with your dog? (e.g. any specific collars, clickers, whistles, etc.):
Please provide any other information you feel mighty be relevent regarding your dog's training:
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ENVIRONMENT
Background
Time in current home:
Where did your dog come from?
Brief history from previous home (if known):
In The Home
Please provide details of other people living in the home: (Name, Age, Gender, Relationship with dog.)
Please provide details of other animals living in the home: (Type , Name, Age, Gender, Relationship with dog.)
Where does your dog sleep during the day?
Where does your dog sleep during the night?
Where does your dog eat
Have there been any environmental changes:
In the last three months?
In the last six months?
In the last year?
Has your dog's behaviour changed in the new environment or towards anyone in it?
Any other information you feel might be relevant?
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BEHAVIOUR
How Does Your Dog Behave Generally In The Home?
Are they relaxed or lively?
Relaxed
Lively
Are they happy to be left alone?
Yes
No
Does your dog chew things or toilet in the house when left alone?
Yes
No
How Does Your Dog Behave Generally Outside Of The Home?
When they see other dogs?
When they see other vehicles?
When they see other people including children?
Describe The Behaviour That Is Concerning You:
What exactly is the behaviour, what does your dog do?
How long does it last?
What happens when the behaviour starts?
What happens during the behaviour?
What happens when the behaviour stops?
Does the behaviour happen at a certain time of day?
When does the behaviour occur?
Is it associated with anything specific?
Is anyone else involved?
Are there any changes in the environment that may be linked to the behaviour?
Are there any noises that occur around the time of the behaviour? (Even if it seems very slight to you)
Does there seem to be a particular scenario which prompts your dog to behave this way?
Could the behaviour be prompted by another person or animal? Please provide details.
Please provide any other information about your dog or it's behaviour that you feel may be relevant:
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