BEHAVIOUR QUESTIONNAIRE

BEHAVIOUR QUESTIONNAIRE
General Information

Please fill out this form completely, giving as much detail as possible. This information will be important in the assessment of your dogs behaviour.
Your Name
Address
Email
example@example.com
Phone number
Referring veterinary surgeon
Practice address
Practice phone number
How did you hear about Animal Behaviour Wales?
Information About Your Dog
Name
Date of birth (or approx. age if unknown)
Dog gender and neuter status
If neutered, at what age?
Breed or breed type
How old was your dog when you obtained them?
From where did you obtain your dog? (Rescue, breeder, friend, preloved, Facebook etc)
For what purpose was your dog obtained? (Companionship, showing, dog sports etc)
Briefly describe your dog's mum's personality, if you met her.
Describe your dog's personality, when you first met them and then later as a puppy.
If you are in touch with owners of puppies from the same litter are they having similar behaviour problems?
Is your dog alone during the day?
If yes, for how long?
People in your household (including yourself)
Female adults number Male adults number
Children number Ages of the Children ages

Do you have any other pets at home? (add amount in the relevant boxes)

Describe your pet's personality
Diet
What type of food do you feed your dog?
Which brands?
Is your dog given any supplements?
If yes please give details
When are they fed?
Who usually feeds them?
Do you feed treats, titbits and/or chews? Which does your dog enjoy?
Does your dog have any allergies?
Medical History
Date of last vet examination (approximate date is fine)
Details of all medical or surgical problems with approximate dates
Details of all medication currently or recently taken by your dog
Training, Play and Exercise
What toys and types of play does your dog enjoy?
How much exercise does your dog have each day?
What training has your dog had to date?
How old was your dog at the time?
What methods do you use in training?
How successful was this training?
Describe the type if training (e.g. general dog training, obedience, tricks, agility etc)
What behaviours or tricks can your dog perform?
Does your dog get along with other animals? (please describe their behaviour if not)
How does your dog react to unfamiliar people?
Behaviour Problems
Please describe your dog's problem behaviour in as much detail as possible.

If your dog has more than one behaviour problem, please list them in order of priority. (1 is the issue you would most like to resolve)

When were the problems first noticed?
Fully describe the circumstances in which the behaviour is most likely to occur. Include what happens before and after the behaviour.

How many times a day, week or month does the problem occur?

Has there been a change in the frequency or appearance of the problem? If yes please describe
How do you correct the problem? (e.g. disciplined confined or trained)
How does your dog respond to the correction?
Have you seen any other behaviourists or trainers about this problem? If so please give details?
Were there any significant changes in your dog's environment prior to the appearance of the problem?
How did these changes affect your dog?
Other Problems
Please indicate any other behaviour problems
Describe all situations which are likely to elicit aggressive behaviours, such as growling, nipping, biting, attacking(e.g. stroking, approached by adults, approached by children, in the car, when punished, disturbed while sleeping etc)
And finally...
How much time do you feel able to commit to rehabilitating your dog to resolve these problems?
What do you hope to achieve after my behaviour consultation with your dog?
Is there anything about your circumstances that may affect your ability to train, or require me to assist you in a specific way? (e.g. mobility, health, illness)
What do you envisage happening if the behaviour problem persists? (e.g. manage as best as possible, rehome, euthanasia etc.)
Should be Empty:

General Information