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Client's Name
Address
Postcode
Phone
Email
Vet's Name & Phone
Dog's Name
Age
Breed
Age acquired
From what source, i.e. Breeder, etc
Any formal training yes no
Describe main problems and check boxes below as appropriate
House Soils yes
Jumps Up yes
RunsAway yes
Aggressive yes
Shy yes
Chews yes
Unruly yes
Bites yes
No Obey yes
Pica yes
Digs yes
Fights yes
Barks yes
Howls yes
Coprophagia yes
When does the problem behaviour occur?
Who is present when the behaviour occurs?
Are there times when the behaviour is not a problem?
What is happening just before the behaviour?
Can you bring on the behaviour by doing something?
What usually happens immediately after the dog engages in the behaviour?
How do you react?
When do family members or observers do when the behaviour occurs?
Is the dog rewarded for the behaviour?
Is the dog getting out of doing something with this behaviour?
Diet (including titbits)
Feeding Times
Who Feeds
Does the dog have any daily ritualistic behaviour patterns
If so, what time of day?
Who exercises it?
How often?
How long?
Where it sleeps?
Bedroom access?
Does your dog insist on physical contact?
Favourite game/toy?
Where are toys kept?
Handling/grooming response?
Behaviour with other dogs?
On or off lead on off
Behaviour with other people?
Details of other dogs
Dogs owned previously
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