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Dog Smart Training - Dog Behaviour Consultation
                                           (Registration form)

General Information
Date requested: ...........................................

Name: .......................................................... Pet’s name: ...................................................

Address: .......................................................... Breed: ........................................................

..........................................................................Date of birth: .............................................

Postal Code: ..................................................... Sex: …………………………….

Home phone number: .......................................................... Weight: .................................................

Work phone number: .......................................................... Colour: ...................................................

Email: ..........................................................

Your veterinarian
Vet: .......................................................... Phone: ........................................................................

Address: ........................................................................................................................................

Behaviour problem
What is the main behaviour problem or complaint?

.................................................................................................................................................................

How often does the problem occur (amount of times daily, weekly or monthly)?

.................................................................................................................................................................

What age was your pet when the problem began?

.................................................................................................................................................................

When did it become a serious concern?

..................................................................................................................................................................

In what general circumstances does the problem behaviour occur?

.................................................................................................................................................................

Has this problem changed in frequency or intensity? (Please describe)

.................................................................................................................................................................
Dog Smart Training - Dog Behaviour Consultation
                                           (Registration form)

Has this problem changed since it first began?
..................................................................................................................................................................

Describe the most recent incident:

.................................................................................................................................................................

Describe the first incident:

................................................................................................................................................................

Other significant incidents:

.................................................................................................................................................................

What have you done to try to correct the problem?

.................................................................................................................................................................

List any techniques that have had any success:

..................................................................................................................................................................

List any techniques that have made the problem worse:

..................................................................................................................................................................

How do you discipline your dog when it misbehaves?

..................................................................................................................................................................

Additional problems - Describe briefly if not previously discussed
Destructive digging............................................Y/N Roaming............................................................Y/N

Destructive chewing..........................................Y/N Mounting...........................................................Y/N

Barking..............................................................Y/N Urine marking...................................................Y/N

House soiling (urine)..........................................Y/N Tail biting..........................................................Y/N

House soiling (stool)...........................................Y/N Fly chasing........................................................Y/N

Stool eating......................................................Y/N Uncontrollable urination when excited..............Y/N

Hunting/predation..........................................Y/N Uncontrollable urination when frightened.........Y/N

Jumps up (owner)..............................................Y/n Bedwetting (while sleeping)..............................Y/N

Jumps up (guests)..............................................Y/n Eats non-food items..........................................Y/N

On furniture where not permitted.......................Y/N Licks objects...................................................Y/N
Dog Smart Training - Dog Behaviour Consultation
                                           (Registration form)

In rooms where not permitted...........................Y/N Sleep disorders.................................................Y/N

Pushy wants - Own way......................................Y/N Excitability.......................................................Y/N

Only listens when feels like it............................Y/N Overactive........................................................Y/N

Chews/licks self.................................................Y/N

Shyness/timid – nonaggressive………………………Y/N

(I.e. ears back, cowering, tail tucked, shaking, retreating, hiding etc.)

Describe....................................................................................................................................................

Family etc. -List the people, including yourself, living in your household
Describe how your dog gets along with each family member

................................................................................................................................................................

Please list all other animals in the house

……………………………………………………………………………………………………………………………………………………………

What is your dog’s relationship with other animals (please describe)

………………………………………………………………………………………………………………………………………………………

Dog’s Information
Why did you get your dog? .....................................................................................................................

Why did you choose this breed? ..............................................................................................................

Where did you get this dog? ……………………………………………………………………………………………………………...

Have you owned dogs before? ...............................................................................................................

Describe your dog’s behaviour as a puppy: ............................................................................................

Did you meet the parents? Y/n Describe their behaviour.......................................................................

Has your dog had any other owners? Y/N How many? .............................. Why was the dog given up?

..................................................................................................................................................................

How old was your dog when it was neutered? .......................................................................................

Food
Brand of food: .........................................................................................................................................
Dog Smart Training - Dog Behaviour Consultation
                                           (Registration form)

When fed? ...............................................................................................................................................

How much do you feed? .........................................................................................................................

Who feeds the dog? ................................................................. Where fed? ..........................................

Activity
Amount and frequency of exercise: .........................................................................................................

Who exercises? ....................................................... Type of exercise…………………………………………………

Amount and frequency of play: ..........................................................................................................

Who plays? ............................................................. Type of play .........................................................

Describe a typical 24 hour day in your dog’s life (morning – day – evening – night)

..................................................................................................................................................................

How does the dog behave with visitors? .................................................................................................

How long is the dog home alone each day? ............................................................................................

Dog’s reaction when left alone? ..............................................................................................................

Reaction prior to departure? ..................................................................................................................

Reaction on return? ................................................................................................................................

Training history
Describe any training................................................................................................................................

At what age did classes begin? ............................. Who took the dog to training? ................................

Does your dog know?

Attention - Sit – Down – Come – Stay - walk on loose lead - Off/leave

In what locations/situations are these activities most successful? .........................................................

In what locations/situations are commands least successful? …………………………………………………………….

What family member(s) have most control? ……………………………………………………………………………………..

What family member(s) have least control ...........................................................................................

Medical History
Was there an illness or health problem when the behaviour problem started?
Dog Smart Training - Dog Behaviour Consultation
                                           (Registration form)

..................................................................................................................................................................

Has your dog any medication now?

..................................................................................................................................................................

Has your dog been on medication in the past?

.................................................................................................................................................................

Aggression problems
Please circle yes or no to the following questions regarding your dog’s aggressive behaviour
towards people:

Attacks are sudden and surprising........................................Y/N

Episodes appear unprovoked................................................Y/N

The dog is abruptly docile after an episode..........................Y/N

The dog appears “sorry” afterwards.....................................Y/N

The dog appears disoriented afterward.................................Y/N

The dog appears anxious before the episode........................Y/N

The dog appears anxious after the episode...........................Y/N

Episodes are associated with a “glazed” or absent look.......Y/N

I can usually tell what will set my dog off.............................Y/N

The aggressive behaviour is new and uncharacteristic.........Y/N

How old was your dog the first time he/she growled at a person? ........................................................

How old was your dog the first time he/she snapped or bit a person? ..................................................

Has your dog ever bitten hard enough to break the skin or cause injury? Y/n if yes, please describe:

…………………………………………………………………………………………………………………………………………..................



What parts of the body has the dog bitten and how severe were the injuries?

……………………………………………………………………………………………………..........................................................

List any types of people (children, delivery people) to whom your dog is aggressive:

……………………………………………………………………………………………………………………..........................................
Dog Smart Training - Dog Behaviour Consultation
                                           (Registration form)

Is your dog aggressive to family members? Y/n If yes, who? Describe:

..................................................................................................................................................................

Describe any other situations where your dog barks threateningly:

………………………………………………………………………………………........................................................................

Describe any other situations where your dog growls:

……………………………………………………………………...........................................................................................

When your dog is aggressive, what is your response?

..................................................................................................................................................................

Does your dog act fearful at the time of aggression (cowering, ears back, tail tucked, hackles raised,
retreating, and hiding)? Y/N - Describe a typical situation (including body language)

…………………………………………………………………….........................................................................................

Does your dog ever become aggressive in any of the following situations?
(Please circle)

Pet dog - Hug dog - Lift dog - Call off furniture - Pull/push off furniture - Approach when sleeping

Approach while eating - Touch while eating - Taking dog food away - Taking toys/objects away

Approach while has toy/object - Approach while dog near partner - Reaching towards dog

Person entering or leaving room - Staring at animal - Verbally punish

Physically punish - grooming trimming - Giving medication - On lead - Holding collar

Response to instructions - At the vets -Response to children, toddlers or babies

Unfamiliar person entering garden or house - Familiar adult entering garden or house

Familiar child entering garden or house - People walking by when dog in car

Stranger approaching owner, dog on - On lead – Stranger approaching owner

Dog in house, sees people outside - Response to other dogs, while on lead

Response to other dogs, while not on lead

Any other fact you think we need to know………………………………………………………………………………

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Dog behaviour consultation form 1

  • 1. Dog Smart Training - Dog Behaviour Consultation (Registration form) General Information Date requested: ........................................... Name: .......................................................... Pet’s name: ................................................... Address: .......................................................... Breed: ........................................................ ..........................................................................Date of birth: ............................................. Postal Code: ..................................................... Sex: ……………………………. Home phone number: .......................................................... Weight: ................................................. Work phone number: .......................................................... Colour: ................................................... Email: .......................................................... Your veterinarian Vet: .......................................................... Phone: ........................................................................ Address: ........................................................................................................................................ Behaviour problem What is the main behaviour problem or complaint? ................................................................................................................................................................. How often does the problem occur (amount of times daily, weekly or monthly)? ................................................................................................................................................................. What age was your pet when the problem began? ................................................................................................................................................................. When did it become a serious concern? .................................................................................................................................................................. In what general circumstances does the problem behaviour occur? ................................................................................................................................................................. Has this problem changed in frequency or intensity? (Please describe) .................................................................................................................................................................
  • 2. Dog Smart Training - Dog Behaviour Consultation (Registration form) Has this problem changed since it first began? .................................................................................................................................................................. Describe the most recent incident: ................................................................................................................................................................. Describe the first incident: ................................................................................................................................................................ Other significant incidents: ................................................................................................................................................................. What have you done to try to correct the problem? ................................................................................................................................................................. List any techniques that have had any success: .................................................................................................................................................................. List any techniques that have made the problem worse: .................................................................................................................................................................. How do you discipline your dog when it misbehaves? .................................................................................................................................................................. Additional problems - Describe briefly if not previously discussed Destructive digging............................................Y/N Roaming............................................................Y/N Destructive chewing..........................................Y/N Mounting...........................................................Y/N Barking..............................................................Y/N Urine marking...................................................Y/N House soiling (urine)..........................................Y/N Tail biting..........................................................Y/N House soiling (stool)...........................................Y/N Fly chasing........................................................Y/N Stool eating......................................................Y/N Uncontrollable urination when excited..............Y/N Hunting/predation..........................................Y/N Uncontrollable urination when frightened.........Y/N Jumps up (owner)..............................................Y/n Bedwetting (while sleeping)..............................Y/N Jumps up (guests)..............................................Y/n Eats non-food items..........................................Y/N On furniture where not permitted.......................Y/N Licks objects...................................................Y/N
  • 3. Dog Smart Training - Dog Behaviour Consultation (Registration form) In rooms where not permitted...........................Y/N Sleep disorders.................................................Y/N Pushy wants - Own way......................................Y/N Excitability.......................................................Y/N Only listens when feels like it............................Y/N Overactive........................................................Y/N Chews/licks self.................................................Y/N Shyness/timid – nonaggressive………………………Y/N (I.e. ears back, cowering, tail tucked, shaking, retreating, hiding etc.) Describe.................................................................................................................................................... Family etc. -List the people, including yourself, living in your household Describe how your dog gets along with each family member ................................................................................................................................................................ Please list all other animals in the house …………………………………………………………………………………………………………………………………………………………… What is your dog’s relationship with other animals (please describe) ……………………………………………………………………………………………………………………………………………………… Dog’s Information Why did you get your dog? ..................................................................................................................... Why did you choose this breed? .............................................................................................................. Where did you get this dog? ……………………………………………………………………………………………………………... Have you owned dogs before? ............................................................................................................... Describe your dog’s behaviour as a puppy: ............................................................................................ Did you meet the parents? Y/n Describe their behaviour....................................................................... Has your dog had any other owners? Y/N How many? .............................. Why was the dog given up? .................................................................................................................................................................. How old was your dog when it was neutered? ....................................................................................... Food Brand of food: .........................................................................................................................................
  • 4. Dog Smart Training - Dog Behaviour Consultation (Registration form) When fed? ............................................................................................................................................... How much do you feed? ......................................................................................................................... Who feeds the dog? ................................................................. Where fed? .......................................... Activity Amount and frequency of exercise: ......................................................................................................... Who exercises? ....................................................... Type of exercise………………………………………………… Amount and frequency of play: .......................................................................................................... Who plays? ............................................................. Type of play ......................................................... Describe a typical 24 hour day in your dog’s life (morning – day – evening – night) .................................................................................................................................................................. How does the dog behave with visitors? ................................................................................................. How long is the dog home alone each day? ............................................................................................ Dog’s reaction when left alone? .............................................................................................................. Reaction prior to departure? .................................................................................................................. Reaction on return? ................................................................................................................................ Training history Describe any training................................................................................................................................ At what age did classes begin? ............................. Who took the dog to training? ................................ Does your dog know? Attention - Sit – Down – Come – Stay - walk on loose lead - Off/leave In what locations/situations are these activities most successful? ......................................................... In what locations/situations are commands least successful? ……………………………………………………………. What family member(s) have most control? …………………………………………………………………………………….. What family member(s) have least control ........................................................................................... Medical History Was there an illness or health problem when the behaviour problem started?
  • 5. Dog Smart Training - Dog Behaviour Consultation (Registration form) .................................................................................................................................................................. Has your dog any medication now? .................................................................................................................................................................. Has your dog been on medication in the past? ................................................................................................................................................................. Aggression problems Please circle yes or no to the following questions regarding your dog’s aggressive behaviour towards people: Attacks are sudden and surprising........................................Y/N Episodes appear unprovoked................................................Y/N The dog is abruptly docile after an episode..........................Y/N The dog appears “sorry” afterwards.....................................Y/N The dog appears disoriented afterward.................................Y/N The dog appears anxious before the episode........................Y/N The dog appears anxious after the episode...........................Y/N Episodes are associated with a “glazed” or absent look.......Y/N I can usually tell what will set my dog off.............................Y/N The aggressive behaviour is new and uncharacteristic.........Y/N How old was your dog the first time he/she growled at a person? ........................................................ How old was your dog the first time he/she snapped or bit a person? .................................................. Has your dog ever bitten hard enough to break the skin or cause injury? Y/n if yes, please describe: ………………………………………………………………………………………………………………………………………….................. What parts of the body has the dog bitten and how severe were the injuries? …………………………………………………………………………………………………….......................................................... List any types of people (children, delivery people) to whom your dog is aggressive: ……………………………………………………………………………………………………………………..........................................
  • 6. Dog Smart Training - Dog Behaviour Consultation (Registration form) Is your dog aggressive to family members? Y/n If yes, who? Describe: .................................................................................................................................................................. Describe any other situations where your dog barks threateningly: ………………………………………………………………………………………........................................................................ Describe any other situations where your dog growls: ……………………………………………………………………........................................................................................... When your dog is aggressive, what is your response? .................................................................................................................................................................. Does your dog act fearful at the time of aggression (cowering, ears back, tail tucked, hackles raised, retreating, and hiding)? Y/N - Describe a typical situation (including body language) ……………………………………………………………………......................................................................................... Does your dog ever become aggressive in any of the following situations? (Please circle) Pet dog - Hug dog - Lift dog - Call off furniture - Pull/push off furniture - Approach when sleeping Approach while eating - Touch while eating - Taking dog food away - Taking toys/objects away Approach while has toy/object - Approach while dog near partner - Reaching towards dog Person entering or leaving room - Staring at animal - Verbally punish Physically punish - grooming trimming - Giving medication - On lead - Holding collar Response to instructions - At the vets -Response to children, toddlers or babies Unfamiliar person entering garden or house - Familiar adult entering garden or house Familiar child entering garden or house - People walking by when dog in car Stranger approaching owner, dog on - On lead – Stranger approaching owner Dog in house, sees people outside - Response to other dogs, while on lead Response to other dogs, while not on lead Any other fact you think we need to know………………………………………………………………………………