Ph.: (08) 7480 0597 | Fax: (08) 7480 0596
Email:
184 Main Rd, McLaren Vale, 5171
DOG BEHAVIOUR QUESTIONNAIRE
Please return this questionnaire and any relevant video footage prior to your scheduled consultation.
Please fill this in with as much detail as possible to help us gain a thorough understanding of the problems and make an accurate diagnosis of your pet’s problems. It is helpful if all family members contribute as opinions and perceptions will sometimes differ.
Feel free to leave questions blank if they do not apply or if you are unsure how to answer.
All information shall remain confidential.
OWNER INFORMATION:
Owner:
Address:
Contact numbers:
Email:
PATIENT INFORMATION:
Patient:
Breed:
DOB:
Sex: □ Male □ Female
Is your pet neutered?□ Yes □ No
Weight:
VET INFORMATION:
Clinic:
Vet:
Address:
Phone:
Email:
TRAINER INFORMATION:
Trainer:
Phone:
Email:
REFERRAL INFORMATION:Who referred you to us or how did you hear about our services?
Referee:
Title (vet / trainer / neither):
Company / clinic:
PRESENTING COMPLAINTS / PROBLEMS:
Describe why you are seeking behavioural help for your pet. What problem behaviours are displayed? Please list all issues of concern and all things you would like help with. Please let us know how serious you consider each problem. Please also list how long each problem has been occurring.
Problem / Very Serious / Serious / Not Serious / When did the problem start?- Please also specify contexts and situations when and where the behaviours occur.
GOALS AND EXPECTATIONS
Please briefly describe what you hope and expect to achieve from treatment:
For example:
- To be calm around…
- To cope with…
Has the problem/s been getting worse? □ Yes □ No
Have you previously sought any help from a trainer/behaviourist/vet in regards to your pet’s behaviour? □ Yes □ No
- If yes, please elaborate i.e. when, what, with whom?
MEMBERS OF HOUESDHOLD
Please list the people, including yourself, currently living in the household.
Name / Sex / Age / Relationship (Self, husband, wife, son, mother-in-law etc.) / OccupationIf applicable, please describe any condition that may impact your ability to follow management and treatment recommended by our vets (e.g. mobility issues, sight or hearing difficulties etc.)
Do you have any other pets besides this patient? □Yes □No
- If yes please list your other pets in the home below:
Name / Species / Sex/Desexed / Age and order obtained / Age now
- If yes, describe their relationship with the patient; do they engage well (play/sleep together, groom each other etc.) or do they ignore/avoid each other and/or display aggression?
EARLY LIFE AND DEVELOPMENT
At what age did you get your pet?
From where / whom did you get your pet?
If your pet was from a rescue organisation – why was your dog surrendered?
Why did you choose to get this particular pet?
Has your dog had any previous owners?
If you had your dog as a puppy, please describe its behaviour as a puppy:
Has your dog ever suffered any traumatic or very frightening experiences? (E.g. being attacked by another dog, involved in a severe accident / illness / injury, physical abuse etc.)
□ Yes □ No
- If yes, please elaborate (when, where, what, how):
SOCIABILITY
Was your pet well socialised to lots of people when it was a puppy (i.e. less than 12 weeks old)?
□Yes □No
Was your pet well socialised with lots of other dogs when it was a puppy (i.e. less than 12 weeks of age)? □Yes □No
How does your dog interact with KNOWN / FAMILIAR dogs?
- When on lead:
- When off lead:
How does your dog interact with UNFAMILIAR dogs?
- When on lead:
- When off lead:
- When another dog walks past your property:
Does your dog like being around other dogs?
How does your dog behave around children?
Does your dog enjoy the company of children?
How does your dog react to strangers?
How does your dog react when visitors come to the house?
Where specifically is your dog when you have visitors over and why?
How does your dog react to unfamiliar objects?
How does your dog react to loud noises (e.g. fireworks, thunderstorms, vacuum cleaners etc.)?
Does your dog mount people / objects / other animals? □Yes □No
- If yes describe where, when, what contexts etc.:
How does your dog react / behave at the vets?
How does your dog behave / react in the car?
How does your dog react / behave in new unfamiliar environments?
PERSONALITY AND TEMPERAMENT
Describe your dog’s general personality and temperament.
Has your dog’s personality changed recently or over the course of its life so far?
□ Yes □ No
- If yes, please explain:
Do you consider your dog to be (circle / highlight all that apply):
Shy, timid, fearful, reserved, outgoing, social, confident, cautious, irritable, unpredictable, grumpy, bossy, ambivalent, energetic, lethargic, motivated / unmotivated, excitable, attention-seeking, clingy, needy, hyperactive, restless, noisy, destructive, highly-strung, disobedient, stubborn, depressed, sad, distracted, defensive, aggressive, protective, other?
What best motivates your pet? (circle / highlight all that apply):
praise, food rewards, petting, games, play, tug, ball, training, exercise, punishment, other:
What are your dog’s favourite activities?
Do you think your dog is dominant? □ Yes □ No
- If yes, please explain why?
DAILY LIFE
What kind of a living situation do you have? e.g. rural acreage, house with large yard, house with small yard, townhouse, apartment?
Does your dog attend doggy day care? □ Yes □ No
On average how many hours is your dog left alone each day?
Where specifically is your dog when it’s left alone?
How many times is your dog walked or exercised per day?
If your pet is walked, what is the average length of time for each walk / exercise session (in minutes)?
With what / how do you walk your dog? Choose from the following:
Off leash, Soft collar, choker chain, prong collar, shock collar, halti/head collar, harness, front attaching harness, other.
Does your dog pull on the lead? □Yes □No
How often is your pet fed meals each day?
How often is your pet fed treats each day?
Do you use any creative feeding techniques (e.g. puzzle feeders, stuffed Kong’s, long lasting chews/bones, treat balls, Bobalots etc.)? □ Yes □ No
- If yes, what and how often?
What does your dog do as you prepare to depart the house?
How does your dog react when you arrive home?
Does your dog ever try to escape your property? □ Yes □ No
Does your dog engage in destructive behaviours, barking or urinating / defecating inside the house when left alone? □ Yes □ No
Does your dog eat while you are away from home? □Yes □No
Does your dog chase its tail or display any other behaviours you think are odd or harmful to itself?
□Yes □No
- Please specify:
Have you ever had any complaints from the neighbours about your dog? □Yes □No
- If yes, please specify.
Where does your dog sleep during the day?
Where does your dog sleep throughout the night?
Does your dog routinely sleep deeply and normally during the day / night? (Normal dogs may spend 10-16 hours per day in peaceful rest or sleep). □ Yes □ No
What exactly is your pet fed (include brand names)?
Where and when is your pet fed?
Describe your typical household atmosphere (e.g. noisy, calm, lots of commotion, always people present, lots of visitors, very structured and routine, always changing)?
Has your household changed since acquiring this pet? □Yes □No
- If yes, how? E.g. moved home, renovations, marriage, divorce, death, illness, new family members, members leaving, new pets, change of jobs or routines, babies born etc.
Briefly describe a typical day in the life of your pet, basic dot points are fine:
6am - 10am:
10am - 2pm
2pm - 6pm
6pm-10pm.
Briefly, how would you describe your relationship with your dog and the relationship between all of the other family members and your dog?
TRAINING AND OBEDIENCE
What is your dog’s obedience and training history?
□ Absolutely no training at all
□ I trained my dog myself
□Puppy pre-school / kindergarten
□Group lessons – basic
□Group lessons – advanced
□Private trainer – one on one sessions with you
□Private trainer – sent to trainer remotely (e.g.board and train)
Age when your dog started lessons/training?
Who does the majority of your dog’s training?
How did your dog do in obedience school?
Is your dog more obedient in certain situations that others? □Yes □No
Please specify?
Is your dog more obedient with certain people than others? □Yes □No
Please specify:
How do you rate your dog’s learning, concentration and training ability? Choose from the following:
□ Extremely good
□ good
□ average
□ poor
□ impossible
Which of the following methods do you use when training your dog or generally encouraging / discouraging behaviour?:
□Positive reinforcement (giving something pleasant when it behaves)
E.g. giving it a treat or pat or praise when it does something good.
□ Negative reinforcement (taking away something unpleasant when it behaves)
E.g. loosening pressure from a choker chain around your dog’s neck when it sits.
□ Positive punishment (applying an unpleasant stimulus when the pet misbehaves)
E.g. yelling at or hitting your dog when it does something you don’t like
□ Negative punishment (taking away something the pet likes when it misbehaves)
E.g. ignoring your dog or giving it time out (removing your attention)
Have you tried punishing your dog previously when it behaves in a way you consider inappropriate?
□Yes □No
- If yes, which of the following punishment techniques have you used?
□ Staring
□ yelling
□ physically striking (hitting / kicking etc.)
□ Scruffing
□ Leash jerks / choking with chain
□ trying to intimidate with voice or body language
□ alpha roll
□ forcing a dominance down
□ time out
□ taking away privileges
□ withholding food
□ ignoring
□ saying “NO”
□ electric shock collar
□ citronella collar
□ spraying with water bottle
□ tying up or confining
□ other - please specify:
Please describe how your pet reacts to being punished?
If / when your dog does the right thing or something you like or approve of, how do you react or what do you do to reward the dog? Tick all that apply.
□ verbal praise
□ eye contact / smiling
□ food / treats
□ play / games
□ physical touch - pats, massage, roughing up etc.
□ going for a walk or other exercise
□ a training session
□ cuddles
□ clicker
□ allowing them access to inside
□ other - please specify:
MEDICAL HISTORY
Does your pet currently suffer from any medical issues or diseases?
□ Yes □ No
- If yes, please list and describe:
Does your pet have any current or chronic source of pain or discomfort? (e.g. itchy skin, ear infections, dental disease, arthritis, irritable bowel?)
□ Yes □ No
- If yes, please elaborate:
Is your dog protective / sensitive of certain body parts or reacts when they are touched?
□Yes □No
- If yes, please specify:
Is your pet currently taking any medications, supplements or special prescription diets? (e.g. eg flea and worm preventative, Hill's Z/D, arthritis medications.)
□ Yes □ No
- If yes, please elaborate:
Describe your pet’s appetite: (excessively hungry, normal, fussy, reduced appetite)
Does your pet have any issues with toileting? i.e. toileting inside □ Yes □ No
- If yes, please describe:
Has your pet previously, or is your pet currently taking any medications for its behaviourproblems? (including supplements and pheromone, e.g. Rescue Remedy, Canine Tranquil Formula, Adaptil)
□ Yes □ No
- If so, please list (including, drug name, dose amount and how long they’ve been on the medication):
YOUR FEELINGS
How does your dog’s behaviour problem affect your life?
How does your dog’s behaviour problem affect the relationship and bond between you, your family and your dog?
Does your dog’s behaviour cause conflict or arguments within the family at home?
□ Yes □ No
Why do you think your dog displays its unwanted behaviour?
Do you believe your dog is suffering? □ Yes □ No
How would you describe your dog’s overall quality of life?
Do you feel your dog has a mental health problem? □ Yes □ No
Why have you kept your dog despite its behaviour problem?
Are you concerned that you may have caused the problem? □ Yes □ No
Why?
Do you feel guilty about this problem?□ Yes □ No
- Why?
Have you considered finding another home for this pet?□ Yes □ No
Have you ever considered euthanasia (putting your pet to sleep) for this problem?
□ Yes □ No
Did someone recommend euthanasia before your visit here?□ Yes □ No
Which of these statements apply to you:
☐ I am here only out of curiosity; the problem is not serious.☐ I would like to change the problem, but it is not serious.
☐ The problem is serious; I would like to change it, but if it remains unchanged that is alright.
☐ The problem is very serious; I would like to change it, but if it remains unchanged I will keep my dog.
☐ The problem is very serious; if it remains unchanged I will euthanise or rehome my dog.
AGGRESSION - Please complete the following section IF your dog displays ANY aggression.
CANINE AGGRESSION SCREEN
Tick the boxes which apply in the following table.
Key:
NA = not applicable / doesn’t occur
No Reaction = Dog does not react/ they feel comfortable with the situation
Fearful = Fearful behaviour, including freezing
Snarl/Lip Lift = lifting of lips to show teeth
Bark/Growl = Barking and/or growling
Snap/Bite = Snapping and or biting
*** NOTE: if unsure of your dog’s reaction but you are worried any of these stimuli may cause aggression DO NOT attempt to replicate these scenarios to find out. DO NOT endanger the dog, yourself or any other person / animal.
How does your dog react to YOU in the following situations? / N/A / No reaction / Fearful / Bark/growl / Snarl/
lip lift / Snap/ Bite
Take away food dish with food
Take away empty food dish
Take away water dish
Take away food (human) that falls on floor
Take away treat
Take away toy or other object
Approaching dog while eating
Approaching dog while playing with toys
approaching/disturbing dog while sleeping
Step over dog while resting / sleeping
Push dog off bed / furniture
Reach toward dog with hand
Reach over head / touch head
Put on leash / collar / harness
Touch / hold / handle paws
Bathe / wash dog
Touch / hold / handle dog’s head
Touch / hold / handle dog’s body
Human stares at dog
Touch / hold / handle muzzle / mouth
Push dog over onto back
How does your dog react IN GENERAL in the following situations? / N/A / No reaction / Fearful / Bark/
growl / Snarl/
lip lift / Snap/ Bite
Dog during vet consults
Dog in car
Dog in veterinarian’s office or waiting room
Dog in boarding kennel
Dog at groomer
Dog yelled at
Dog corrected with leash jerk / choke
Dog physically pushed – hit
Someone raises voice to owner in presence of dog
Someone hugs/touches owner in presence of dog
Dog sees cats / small animals
Bicycles, skateboards, scooters going past
Crying infant
Interacting with toddlers
Interacting with 5 to 7 year old children
Interacting with 8 to 11 year old children
Interacting with 12 to 16 year old children
Unfamiliar dog approaches while dog free off-lead
Unfamiliar
How does your dog react to STRANGE HUMANS in the following situations? / N/A / No reaction / Fearful / Bark/
growl / Snarl/
lip lift / Snap/ Bite
person approaches while dog free off-lead
Human approaches dog while playing with toys
Human approaches/disturbs dog while sleeping
Reach toward dog with hand
Reach over head / touch head
Touch / hold / handle paws
Touch / hold / handle dog’s head
Touch / hold / handle dog’s body
Human stares at dog
Touch / hold / handle muzzle / mouth
Stranger knocks on door
Stranger enters room
Dog on leash approached by unfamiliar person on street
Dog in yard – unfamiliar person passes
How does your dog react to DOGS in the following situations? / N/A / No reaction / Fearful / Bark/
growl / Snarl/
lip lift / Snap/ Bite
Another dog approaches dog while eating
Another dog approaches dog while playing with toys
Another dog mounts / humps them
Another dog staring at them
Dog on leash approached by unfamiliar dog on street
Dog in yard – unfamiliar dog passes
Are there any other situations or contexts not listed above in which your dog has already or may display aggression: □Yes □No