Paul Lasky Dog Behaviour Diagnostic Form

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Name
First Name
Last Name
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AddressPlease enter first line of address and this will auto-complete
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
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Liberia
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Mali
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Mayotte
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Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
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Saint Lucia
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eSwatini
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Other
Country
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Mobile Phone Number (Please make sure this is mobile number if you have one, not landline)
Area Code
Phone Number
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Email
example@example.com
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Where did you here about us?
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Do you have any disabilities that I need to / you would like me to know about?
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Dog's Name.
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Sex of Dog
Male
Female
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Dog Breed
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Dog's Weight (kg)
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Dog's Date of Birth
Date
Year
Month
Day
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Dog' s Age (at time of completing form)
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Is the dog neutered? If so, at what age was the dog neutered?
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Please provide name and town of vets
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Date of last Vaccination
Date
Year
Month
Day
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Date of last worm treatment
Date
Year
Month
Day
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Date of last flea treatment
Date
Year
Month
Day
18
What equipment do you walk your dog on? (e.g. lead, harness, collar, martingale, slip lead, choke chain, prong collar)
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How long have you owned your puppy/dog?
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Early Years (if known):Please give as many details as you can (age of weaning, litter size, parents character, raised inside or outside, hand reared? Did your dog attend puppy socialisation classes? Interact with people and other animals?
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Did you see mother? (If so, please briefly describe her confidence level e.g. social/worried barky.)
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Did you see father? (If so, please briefly describe her confidence level e.g. social/worried barky.)
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Did you see the litter?
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Are there any other pets at home? If so please detail species, age, sex, temperament
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Are there any other animals regularly visiting the property? If so please detail how often, species, age, sex, temperament
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How many people live with the dog? Please specify age, sex and how much involvement they have with the dog/s
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How does your dog behave with new visitors? Please give detail.
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As an example, how long ago since you received a visitor that your dog didn’t know and how did it go?
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What does your dog do around new dogs?
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What does your dog do around new people, outside the home?
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Has your dog lived with any other animals in the past that you no longer have?
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Have there been any major changes at home? (e.g. someone leaving/a new person arriving/building works/tension between humans/anything else.) Please state if there is building work currently going on.
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Has your dog ever been aggressive, threatening or bitten any other dogs or any people?If so please give as much detail about these occurrences as possible. This includes grumbling, growling and snapping without making contact.
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Do you feel your dog is ever stronger than you? Can you control your dog at all times? Has your dog ever pulled you over or got free from your control?
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Please describe in as much detail as possible any other behaviour problems, you may be experiencing with your dog. Including when did these problems first appear?
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When did these behaviours start? Can you attribute any incident or time period that may have initiated or contributed to the problems?
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Have you identified any other reason for these behaviours starting initially? If yes please describe:What do you hope to ultimately achieve with your dog?
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What is usually happening just before the behaviour starts?
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Do these behaviours happen at a certain time of day?
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Do these behaviours happen when only certain people are present?
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Do these behaviours happen in certain places?
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How do you currently respond to the behaviours? How does the dog respond to these responses?
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Is your dog currently undergoing any treatment with your vet? If yes please give details: Please also include historical medical information or conditions.
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Was your dog undergoing any treatment when the behaviour first appeared?
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Is your dog allergic to anything that you are aware of? i.e. foods, grass, pollen etc?
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Has your dog had a full clinical check since the behaviour started? If yes, what was the outcome? Did the vet take blood tests? If yes, what were the results?
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What brand of food do you feed your dog? (e.g. James WellBeloved, Burns etc…) And what amounts?What product name? (e.g. ‘Junior Dog’ Chicken and Rice etc…) Is this ‘dry’ or ‘wet’ food?
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What supplementary foods does your dog eat? Bones, chews, animal parts, treats, supplements
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At what times do you feed your dog?Where is your dog fed? Who feeds him/her? How is your dog fed? (i.e. bowl, activity ball, Kong,hand fed)
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Will the dog eat if you are not home? How quickly does he/she eat?
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How would you describe your dog’s personality?Is your dog frightened of anything? Please give details? If frightened how does he/she show it?
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Training Classes / behaviour training:Have you worked with previous training classes or behaviourists with your dog? If yes: At what age? What methods were used? How did your dog do?
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How good do you think your dog is at learning?
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Does your dog struggle to carry out any commands? (e.g. recall)
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Does your dog obey certain members of the family more than others? If so who?
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Is your dog corrected if he/she misbehaves? If yes how?
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Who feeds, walks, trains and plays with the dog?
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What are the working hours of every member of the household and therefore how long is the dog left alone on an average day?
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Do you groom your dog? If so how often?
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Where does your dog sleep?
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Will the dog get off beds/furniture when asked?
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Does your dog ever wake you during the night? If yes, for what reason?
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How many times a day do you walk your dog?How long on average are you out walking your dog per day?
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Is the dog on lead for all of the walk?If allowed off lead, for how long per walk?
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Do you take part in any canine sports with your dog? (e.g. Flyball, Agility etc)?
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Does your dog prefer to play with other dogs, alone or with family members?
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If you play with your dog, who initiates the play?
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What type of toys does your dog play with?
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Does your dog get to mix with and play with other dogs? Please give details
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Does your dog have any of the following tendencies or behaviours? If so how often? Often/sometimes?Stealing food, Eating excrement, Sexual behaviour towards humans, Sexual behaviour towards dogs, Excessive fearfulness, Excessive scratching or licking, Object guarding, Location guarding, Barks or growls at strangers, Biting strangers, Growls at or bites family members, Aggressive when petted, Aggressive when brushed, Aggressive when touched, Aggressive when pushed/shoved, Aggressive when picked up, Aggressive when punished, Aggressive when woken up or disturbed, Aggressive when eating, Urinating in the home, Defecating in the home, Destructive in the home, Excessive whining or barking
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Is there any other information you feel is relevant to your dogs behaviour?
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Please list in order of priority what you would like to get out of working with me
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