Your Details
Name * Full Address * Mobile * Email * Typical availability * When are you available for a consultation? Disabilities Please advise if you have any disability, health of physical issue we should be aware of that would effect your ability to participate in training your dog.
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Dog's Details
Name * Breed * Date of Birth * Or best guess if not known. Age * Gender *Male Female NeuteredYes No Age when neuteredPlease enter "not known" if you don't know.
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Dog's Medical History
Vaccination History * Is your dog up to date on vaccinations or titre tests? Flea & Tick Prevention * Please give the name of the treatments. Physical Problems Please detail any physical problems that your vet has noted. Medication Please detail any medication that has been prescribed for your dog.
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Dog's Origin
Age when acquired *How old was the dog when you brought them into the home? From where? * Describe the dog's last home Previous owners * How many previous owners has your dog had? Parents Did you meet the dog's parents, and if so do you have any comments on the parents' personalities? Litter How many puppies in the litter? Puppies environment Where were the puppies kept, e.g. in the house, kennel, barn? How were the puppies fed, e.g. individual bowls, one bowl for all? Where the puppies in crates? Puppies health Have any of the littermates been diagnosed with medical or behavioural issues Why * Why did you choose this specific dog?
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Family
Number of Adults * Comments Do you have any comments on the relationship between the dog and any of the adults in the family? Number of Teenagers * Comments Do you have any comments on the relationship between the dog and any of the teenagers in the family? Number of Children * Comments Do you have any comments on the relationship between the dog and any of the children in the family? Number of Toddlers * Comments Do you have any comments on the relationship between the dog and any of the toddlers in the family? Number of Babies * Comments Do you have any comments on the relationship between the dog and any of the babies in the family? Number of Dogs * Comments Do you have any comments on the relationship between the dog and any of the dogs in the family? Number of Cats * Comments Do you have any comments on the relationship between the dog and any of the cats in the family? Number of Other Animals * Comments Do you have any comments on the relationship between the dog and any of the other animals in the family?
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Routines
Daily Routine * Please describe the dog's daily routine. Diet * What's the name and brand of the food your dog eats, including any regular treats? Live and Sleep * Where does the dog spend most of his time? What are the dog's sleeping arrangement and sleeping habits? How much sleep does the dog get?
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Training
Behaviours Please list any behaviours that your dog can perform on cue. Formal Training Please detail any training courses or training sessions that your dog has attended. Informal Training Activities Do you do or have you done any activities with your dog such as agility or scent work?
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Separation
Leaving the house * What do you do when preparing to leave the house? Dog's response * What's your dog's response to you leaving the house? Dog's behaviour * Does your dog do any of these when left alone? Salivate Toilet Hide Escape Destroy Freeze Pant Pace Refuse food Bark/growl Lunge Yawn Chase Tremble/Shake Seek out people Eat Drink Comments Do you have anything else to say about separation?
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Noise Response
Dog's response Does your dog respond negatively to any of the following? Thunder Fireworks Gunshots Vehicles Domestic noises e.g. washing machine, hoover Dog's behaviour If your dog response to noises, what behaviours does the dog display Salivate Toilet Hide Escape Destroy Freeze Pant Pace Refuse food Bark/growl Lunge Yawn Chase Snap/bite Tremble/Shake Seek out people Comments Do you have anything else to say about noise sensitivity?
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Dog/Human Struggle
Dog's response to people In response to adults or children, does your dog do any of the following behaviours? Salivate Toilet Hide Escape Destroy Freeze Pant Pace Refuse food Bark/growl Lunge Yawn Chase Snap/bite Tremble/Shake Seek out people Trigger What specifically triggers this response? Comments Do you have anything else to say about how your dog reacts to people?
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Dog/Dog Struggle
Dog's response to dogs In response to adult dogs or puppies, does your dog do any of the following behaviours? Salivate Toilet Hide Escape Destroy Freeze Pant Pace Refuse food Bark/growl Lunge Yawn Chase Snap/bite Tremble/Shake Seek out people Trigger What specifically triggers this response? Comments Do you have anything else to say about how your dog reacts to other dogs?
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Resource Guarding Information
Dog's response to resources In response to a person or dog approaching them when they have a resource (something they value, e.g. food or toy), does your dog do any of the following behaviours? Salivate Toilet Hide Escape Destroy Freeze Pant Pace Refuse food Bark/growl Lunge Yawn Chase Snap/bite Tremble/Shake Seek out people Trigger What specifically triggers this response? Comments Do you have anything else to say about your dog resource guarding?
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Struggle History
Problem * Please give details of the issue. Occurrence * When did the issue first occur? Development * Did it occur suddenly or develop slowly over time? Progress Has the issue progressed, either for the better or worse? Treatment History What, if anything, has been tried to resolve the problem? Other Information Is there anything else you feel we should know? Expectations * What are your expectations with regards to rehabilitation? Terms and Conditions and I consent to the information submitted being shared with On Cloud K9 , Lifeline Dogs , South Wales Dog Training Academy , Helping Hounds or Animal Behaviour Consultations in order to provide the best service. Signed By * On *
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