Behaviour Consult Questionnaire To be filled in at least 2 days prior to a behaviour consult lessonClient InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail* VeterinarianHow did you hear about Dog Matters?Dog InformationDog's NameBreedAgeSex Male FemaleDesexed? Yes NoAge when desexed:Was your dog desexed due to a behaviour problem?Did notice a difference in your dog after desexing?Are your dog's vaccinations up to date?To the best of your knowledge, have you ever had a dog with parvovirus on your property?Does your dog have any medical conditions? If so, please explain, including any medications that your dog is onGeneral InformationHow old was your dog when you acquired it?Had the dog had previous owners? If yes, please explainWhere did you get your dog? Breeder Pet Store Animal shelter Friend OtherIs your dog allowed inside? If no, why is this? If yes, how often?What type of exercise does your dog receive and how often?When is your dog fed? Morning Evening BothWhat do you feed your dog? Canned food Dry food Table scraps Raw dietIf you feed dog food, which brand is it?Which best describes your dog's eating habits? Fussy Normal appetite GluttonousIf your dog doesn't eat all food at once, how long is the food left down?Where does your dog sleep? On the bed Kennel On own bed, inside On own bed, outside In a crate OtherDoes your dog have any toilet training problems?Family & Other People & AnimalsPlease desribe the social layout of the family (people and pets) and the dog's place in itHas your household changed since acquiring the dog? If so, please explainDoes your dog like children? If not, explainPlease explain how your dog gets along with other animals in the householdHow does your dog react to guests and strangers?How does your dog react to unknown dogs?Dog SelectionWhy did you decide to get a dog? Companion For child ProtectionAnything unusual as a puppy?Why did you choose this breed?Have you owned other dogs in the past and if so which type/s?While You Are OutDescribe your dog's reaction to being left aloneWhere do you leave your dog when you go out?Describe your dog's reaction when you return homeDo you use a crate? Yes NoPrevious TrainingHas your dog ever been to obedience school or private lessons? If so, where did your dog attend and for how long?Will your dog lie down on command?Does your dog pull on the lead when being walked?What equipment do you use to walk your dog? ie flat collar, check chain, harness, flexi leadReason For ConsultWhat is your dog's most undesirable behaviour?Please list all other undesired behaviours in order of highest priority to lowestHas there been a change in frequency or severity of the problem? Please describeWhat have you tried so far to fix the problem?Why do you think the dog is displaying these behaviour problems?Please list any commands that your dog knows reliably:AggressionDescribe any and all instances of aggressionFinal CommentsAny additional comments or information you think I should know?ΔIf you are on Facebook, please join our client facebook group here