Canine Behaviour Consultation Questionnaire

  • Date Format: MM slash DD slash YYYY

  • GENERAL INFORMATION:

  • CO-OWNER'S NAME AND CONTACT INFO:

  • PET INFORMATION:

  • Date Format: MM slash DD slash YYYY

  • THE HOME ENVIRONMENT

  • REINFORCER ASSESSMENT

  • DAILY ACTIVITIES AND ROUTINE

  • TRAINING

  • For each of the following use a scale of 1 (poor) to 5 (excellent) to indicate how your dog responds.

  • PUNISHMENT

    Have you ever used any of the following for punishment or training?

  • HANDLING

    How does the dog react to the following types of handling?

  • HOUSETRAINING SCREEN:

  • MEDICAL SCREENING

  • If this is a referred case, please have your veterinarian complete the medical section of this questionnaire.

  • DEPARTURE BEHAVIOUR SCREENING:

  • REACTIVITY:

    Indicate how your dog reacts to each of the following (check all that apply):

  • AGGRESSION SCREEN:

  • Situations causing aggression:

  • If there have been no signs of aggression (growl, bite attempts, biting) or if it has been entirely resolved, then proceed to PRINCIPAL COMPLAINT.

  • PRINCIPAL COMPLAINT:

  • Please answer all of the following unless they have been entirely covered in another section:

  • MISCELLANEOUS

    Please answer any of the following that have not been previously discussed.

  • Disobedient:

  • Anxiety/fear: