Phone Number *
Email *
Dog's Name *
Dog's Breed *
Dog's Gender * Female Male
Has your dog been neutered or spayed? * Yes No
Are you the first owner of your dog? * Yes No
Veterinarian Name *
Have you owned dogs before? * Yes No
Why did you decide to get this particular dog?
Did you meet the parents of the litter? Yes No
Was a temperament test performed? Yes No
If yes, please briefly describe the results of the test
Does your dog enjoy food or are they a fussy eater? Enjoys food Fussy eater
Does he/she spend time playing with other dogs? Yes No
Please describe your dog's interaction with other dogs
Does he/she have time off lead to run loose? Yes No
Does your dog have access to a garden? Yes No
If yes, please describe your dog's access and use of the garden
Please outline a typical 24 hours in your dog’s life
Please describe the problems you are having with your dog in as much detail as possible
What happens immediately before these behaviours are displayed? Try to think about what you and your dog are doing when the problem occurs
What happens immediately after these behaviours are displayed? Again, try thinking about what you do and what your dog does
Are there any particular circumstances in which the problem occurs now?
How frequently does the problem occur?
Is it becoming more frequent, less or about the same? More frequent Less frequent About the same
Has your dog previously been assessed by another behaviourist? Yes No
Please provide any further details you think might be important
How much time do you feel you can commit to working to solve the problems?
What is your ideal end scenario to achieve from this behaviour assessment?
What would you envisage happening if the problems persists?
