NorAus Canine Services
Assessment Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Address
*
Street Address
Street Address Line 2
Suburb
Post code
Name, breed and age dog 1
*
Dog 1 - Sex, desexed or entire?
*
Male
Female
Desexed
Entire
Name, breed and age dog 2
Leave blank if only one dog.
Dog 2 - Sex, desexed or entire? Leave blank if only one dog
Male
Female
Desexed
Entire
Where did you get the dog(s) from?
Breeder
Shelter/Pound etc
Friends/family
How old were the dogs when you got them?
*
Any other pets in the household, if so, please elaborate
Have you owned and trained dogs in the past?
*
Yes, same breed
Yes, different breed(s)
No
Owned, but never trained
Why did you choose this breed?
Are you ever afraid of your dog or worried that the dog(s) might injure another person oranimal
*
Yes
No
If you answered yes to the last question, please elaborate
Approximately how many hours a day is your dog home alone?
What type of exercise does your dog get on a daily basis and how much? E.g. half hour walks plus games
Has the dog free access to toys 24/7?
*
Yes
No
Has the dog free access to food 24/7?
*
No
Yes
Is the dog allowed inside the house?
*
Yes
No
If dog is not allowed inside the house, please elaborate
Is your dog crate trained?
*
No
Yes
Is the dog allowed up on elevated areas such as beds, couches etc?
*
Yes
No
Has the dog had any formal obedience training in the past? If yes, please provide some brief details.
*
Problem behaviours, if any?
At what age did this behaviours start?
What triggers the behaviours (e.g. cyclists, skate boards, people running, other dogs etc):
Has the dog ever attempted to bite another animal or a human?
*
No
Yes
Has the dog actually bitten a person or an animal?
*
No
Yes
If you answered "yes" either of the last two questions, please elaborate
Have you taken, or do you currently take the dog to off leash dog parks or dog daycare? If“Yes”, please stop doing this immediately.
*
Yes
No
Have done so in the past
Only when there are no other dogs in the park
Any additional information which might be of help?
I need help with (tick all that applies):
*
Pulling on leash
Jumping on people
Digging
Chewing
Barking
Aggression/Reactivity
Anxiety
Not coming when called
Toilet training
General obedience
Resource guarding
Training availability – what are your preferred days and times?
*
I understand and accept I will be charged $300,- for the assessment.
*
Accept
Submit
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