Owner Name:
Address Line 1:
Address Line 2:
State:
Postcode
Phone:
Email
Have you had problems with past pets? If yes, please explain:
How old was your pet when you first acquired it?
How long have you had this pet?
Has this pet had other owners? If so, how many?
Do you know why the pet was rehomed?
Why did you choose this breed?
Have you had this particular breed before?
Why did you choose this particular pet?
Did you see the mother and father?
Did you see the litter mates?
Was the pet temperament tested?
Do you have contact with any of the litter mates?
Has your pet been spayed or castrated? If yes, at what age?
Reason for desexing?
Does your pet mount? If yes, what (people / other pets / objects) and when?
Did your pet show any behaviour changes after desexing?
If your pet hasn’t been desexed, do you plan to breed from your pet?
Has this pet ever been bred?
If female, did she experience any heat cycles before desexing?
Age of first heat?
Does your pet have any medical problems?
Is your pet taking any medications?
Please list any other pets in the household. Include Pet name, Breed, Sex, Age Obtained and Age Now.
Please list all family members living in the house. Include their Name, Sex, Age, Relationship (self, husband, son, daughter etc) and Time Spent at Home.
What percentage of the time does your pet spend inside and outside each day?
How many times is your pet walked each day and for how long (on average)?
Who exercises your pet?
What type of toys does your pet have?
What games do you play with your pet?
How often during the day do you play with toys or play games with your pet inside the house?
On average how long are these sessions?
How often during the day do you play with toys or play games with your pet outside the house?
On average how long are these sessions?
How does your pet behave with familiar visitors?
How does your pet behave with unfamiliar visitors?
How does your pet react to visits to the vet?
Has your pet stayed in boarding kennels or a cattery? If yes, how did they behave?
Has the pet been to a groomer? If yes, how did they behave?
Where is your pet if they are alone in the house?
Where is your pet when you have guests? Why?
How often do you feed your pet?
What do you feed your pet - include brands and amounts:
Where and what does your pet drink?
Who feeds your pet?
Where and when does your pet get fed?
Does your pet eat alone?
How often does your pet get treats each day? What do you use?
Does your pet get snacks from the table? How often?
Describe in detail how you prepare to leave the house when your pet is going to be left alone and what your pet does as you prepare to leave the house:
Describe your pet’s reaction as you leave and when you return to the house:
Describe a typical 24 hours in your pets life – wakes, sleeps, exercised etc
Any other comments?
What age was your dog when he / she started lessons / training?
Who took your dog to obedience school?
How does your dog behave at obedience school?
What commands does your dog know and how well does your dog perform them for each member of the family? Include Family Member's Name and your dogs knowledge of Sit, Down / Drop, Stay, Come, Heel
Describe any other commands or tricks your dog can do:
Describe each situation:
For each of the problems listed above that you are concerned about please fill out the following questions – separately for each problem. Describe the problem:
How frequently does it occur? Daily / Weekly /monthly etc
How old was your dog when you first noticed the behaviour?
In what circumstances does the problem occur?
When did the problem become serious? Why?
Has the problem changed in frequency or intensity?
For each problem that you are concerned about please describe the following – Most recent incident – date
Second last incident – date
Third last incident – date
What have you done to try and correct the problem?
Any other comments?
Stereotypic or Ritualistic Behaviour
Was there a change in the household or an event that seemed to be associated with the development of the behaviour?
Is there a time of day or location when the behaviour occurs? When? Where?
Is there a person the behaviour seems to occur in conjunction with? Who?
Has your dog’s general behaviour changed in any way since the onset of the atypical behaviour? i.e. become more aloof, more aggressive
What is the attitude of your dog while performing the behaviour? Distressed, self-absorbed, fearful etc
Can you distract your dog during the behaviour? If so how? calling, physical restraint etc
Is there a pattern to the behaviour? Duration (days, weeks, months), Frequency (hourly, daily, weekly, monthly, sporadic) and Pattern (after meals, in the morning. be specific)
What do you do when the behaviour starts?
If you are human, leave this field blank.
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