PupStart Behaviour Questionnaire

Puppy Training Questionnaire
Please return this form at least 48 hours prior to your appointment.
This will help me to fully prepare for the consultation.
General Information

Please fill out this form carefully and completely. The information you provide will be very important for diagnosing and treating your pet's behaviour.
Owner
Address
Email
example@example.com
Phone number
Vet
Referred by/How did you hear about us?
Information about your pet
Pet's Name
Date of birth
Type of pet

DogCatOther
Breed
Dog gender & neuter status

Female EntireFemale NeuteredMale EntireMale Neutered
If neutered, at what age?
Colour
Weight (approx)
At what age did you obtain the pet?
From where did you obtain this pet? (Rescue, breeder, friend, preloved, Facebook etc?)
For what purpose was the pet obtained? (Companionship, showing, dog sports etc)

Percentage of daily time spent:

	Daily time (%)
Inside
Outside

Is your pet left alone during the day?

YesNo
If yes, for how long?

In what area of the house is the pet kept when:

	Area of house/garden
The family are at home
The family are not at home
Guests are visiting

How many adult female humans live in the home?
How many adult male humans live in the home?
How many children live in the home?
Ages of the children

Are there any other pets in the home? (add amout of each in the relevant box)

	Entire	Neutered
Dogs
Cats
Other

Describe your pet's personality
Diet
What type of food do you feed your pet?

RawDryCanned/pouchesOther
Which brand(s)?
Is your dog given any supplements?

YesNo
If yes, please list here:
What treats and/or chews does your pet enjoy?
When is the pet fed?
By who?
Does your pet have any allergies?
Medical history
Date of last vet examination (approximate date is fine)

MonthDayYear
Date
Please list all medical or surgical problems with approximate dates
Please list all medications currently or recently taken by your pet
Training, play and exercise
What toys/types of play does your pet enjoy?
Has your pet had any formal training?

Private lessonsTraining classesTrained yourselfOther
Please grade how successful you felt this training was:

ExcellentGoodFairFailed
What behaviours or tricks can your pet perform?
Is there any particular exercise or trick that you'd like to be able to teach your pet?
If your pet has had his/her jabs, how much exercise does he/she recieve each day?
Does this pet get along with other animals? If not, please describe their behaviour:
How does your pet react to unfamiliar people?
Behaviour
Are you experiencing any behaviour problems with your puppy?
What has been tried to correct the problem?
What was the pet's response to the correction?
Were there any significant changes in the pet's environment prior to the appearance of the problem?

Moved or redecoratedBoarded or in kennelsVisistors (human or pet)Diet changesChanges in family scheduleNew family members/room mates (human or pet)Illnesses or medication changesOther
Please indicate any other behaviour problems:

House soilingDestructive chewingPacingBitesDiggingSleep issuesShynessEats stoolsUnrulyGroomingDestructive scratchingRough playingJumps on peopleSexual issuesBarkingRuns awayRepetitive behaviors (eg. shadow chasing, chasing tail)Pulls on leadFeeding issuesAggressionFightsSwallows non-food itemsOther

Is there any sort of aggression in any of the following circumstances, where aggression includes: growling, snarling (showing teeth), lunging, nipping, biting?

	Adult males	Adult females	Children	Any specific individual
When handling/grooming
If disturbed when resting
If disciplined
When walking on lead
If trying to take food away
When petting or hugging
It taking any other objects away

Are there any other circumstances in which your pet has been aggressive?
What do you hope to achieve in the end with your pet?
Please add anything else that you feel is relevant:
Should be Empty:

Puppy Training Questionnaire

General Information

Information about your pet

Diet

Medical history

Training, play and exercise

Behaviour