Section 1 – General Background This is the first section Handler’s Name: * Phone Email * Dog’s Name * Breed(s) * Approximate weight of your dog * Age of dog * Sex * Female Male Is your dog spayed or neutered? * Yes No End Section Section 2 – Environment and Health Where did you obtain your dog? * How long have you owned your dog? * Name of Veterinarian * Does your dog have any medical issues I should be made aware of? Date of last vaccination * What do you feed your dog (brand name)? * How many meals per day? * Does your dog have any food allergies or foods to avoid? * No Yes Please list any foods to avoid. What are your dog’s favourite treats, toys or activities? * What daily exercise does your dog get? * How often is your dog typically left alone? * Where is your dog kept? – Tick all that apply * In House – Loose In House – Crated In Fenced Yard In Dog Kennel Tied Outside Other Other – Please Specify * Where does your dog sleep? – Tick all that apply * Inside – own bed On my bed In Dog Kennel Tied Outside Other Other – Please Specify * End Section Section 3 – Dog Personality and Behaviour Has your dog ever? Bitten anyone? * No Yes Please give details * Been in a fight with another dog? * No Yes Please give details * Injured another animal? * No Yes Please give details * Is your dog concerned, anxious or fearful of people, other dogs, noise or situations? Please give details. * Which of the following describes how you feel about your dog? – Tick all that apply * Annoyed Confused Frightened Resentful Proud Frustrated I tolerate my dog I love my dog Other Other – Please Specify * End Section Section 4 – Your Concerns and Objectives Please describe the reason(s) for this consultation. Recent situation? Behaviour worsening? * What do you hope to achieve from this ? * Any other questions, comments or concerns? End Section reCAPTCHA If you are human, leave this field blank.