Pre-consultation Questionnaire
Basic Information
Name:
Telephone:
Address:
Directions/Parking:
Veterinary Surgeon:
Name of dog:
Breed of dog (if a cross breed, please describe the cross):
Age:
Sex:
Has your dog been neutered?
If so, when?
Are there any current or previous medical problems?
Has your dog ever received any medication for any behavioural problems?
Early History
Where did you obtain your dog from?
Breeder[]
Private seller []
Friend/Acquaintance []
Puppy farm []
Rescue centre[]
Free[]
Other (please explain):
If obtained from a breeder was the puppy:
Living in a kitchen/living area in the breeder’s home []
Living in a back room at the breeder’s home []
Living in a kennel, barn, garage or shed at breeder’s home []
Did you see the parents of your dog?
Mother []
Father[]
Both[]
Neither[]
How old was your dog when you got him/her?
If rehomed, was there a reason that your dog was rehomed?
If your dog had previous owners, please state how long they owned the dog and reason for giving up the dog:
Training
Has your dog attended any training classes?
If yes, how would you describe his/her behaviour in the classes?
Were there any incidents during the class worth noting?
How well does your dog know the following commands from 0 (no response/doesn’t understand) to 10 (perfect)
Sit
Down
Recall
Leave
Heel
Are there any specific training techniques you have used with your dog, and if so, where have you learnt these from? (Eg books, behaviourists, television)
Your Home
Does your dog live with any other dogs?
If yes, please can you provide information on the other dog (e.g. age, sex, neutered/entire/how the dogs get on):
How many other dogs does your dog meet outside the home, and how does your dog get on with other dogs?
Describe your dog’s have a favourite toy or game:
Where are his/her toys kept?
How much access does your dog have to his/her toys?
How often do you play with your dog?
What are your dog’s favourite treats?
What rooms in the house does your dog have access to?
Where does your dog sleep?
Routine
What dog food do you feed your dog (brand, wet, dry)?
How often and what times?
Is your dog alone during the day?
Yes – all day[]
Yes – all day with a hired dog walker visit[]
Yes – with a family member/friend visit/walk[]
Yes – with a visit from yourself[]
No – Someone is at home most of the day[]
When left alone, is he/she confined to one room or allowed access to all rooms?
How many walks does your dog receive a day?
None[]
1[]
2-3[]
3+[]
How long on average does your dog go out for on each walk?
0-30 minutes[]
30-60 minutes[]
60 minutes+[]
Do you let your dog off the lead when you walk him/her?
If your dog does something you do not like, how do you correct him/her?
If your dog behaves well, how do you reward him/her?
Your Dog’s Social Behaviour
Who is in the household (please include regular visitors/dog walkers/dog sitters):
Name / Age / Relationship to dog / Any issues? / Average amount of time spent with dogWho does your dog respond to the most and least out of your household?
Has your dog ever shown any aggressive behaviour to any members of the household?
Please give details if so
How much interaction does your dog have with strangers?
How does your dog react to visitors?
Are there any specific people your dog shows a reaction to when in the house or on a walk? I.e. Children, men.
How does your dog react when you take toys/treats/food away from him/her?
Are there any areas of his/her body that your dog does not like being handled or touched?
How does your dog react when he/she is taken to the vets?
Has your dog ever been aggressive towards other dogs?
Has your dog ever been attacked by another dog?
The Behaviour Problem
Please describe the general problem you are experiencing with your dog:
Please can you describe the most recent incident of this behaviour:
Can you include details of who was present, what everyone was doing, what happened immediately before the incident, what happened during, how your dog seemed immediately after, and how you reacted to this incident.
If this was an aggressive incident, was there a bite wound and what kind of wound was it (bruise, puncture, red mark, snap, ripped clothes etc)
When did this behavior begin?
How old was your pet when the behaviour started?
When is the behaviour likely to occur?
How often is this behaviour displayed?
Is the behaviour getting worse, better, or staying the same?
What changes would you be prepared to make to be able to live with your dog?
Please describe everything you have tried to stop the behaviour:
Please describe how you would like your ideal dog to act:
Please can you tell me how much time you would be able to dedicate to a behaviour plan?
Has rehoming or euthanasia been considered at all?
If there is anything else you think is important, please add this here:
Where did you hear of Lauren Watts Training, Behaviour and Classes?
Are you happy to receive emails with new classes, workshops and events (for use by myself only and no third parties): YES/NO
Please sign here to confirm that the information you have given in this questionnaire is accurate and true to the best of your knowledge. You also confirm that you have read and understood the terms and conditions.
Name ______
Signed______Date______
Thank you for completing this questionnaire!
Please contact Lauren if you have any questions.
Lauren Watts BSc MRes