Type Of Training Required* Select option Basic Training - £195 plus travel fee if outside 15 miles of PA1 Dog Behaviour Training - £475 plus travel fee if outside 15 miles of PA1 Puppy One to One - £135 plus travel fee if outside 15 miles of PA1 General enquiry Video Call - £95 (45 mins)
Breed*
Age (specify months &/or years i.e 9mnths or 9yrs)*
Gender* Select option Male Female Neutered
Colour*
Do you have pet insurance* Select option Yes No
Which insurance provider *
Have you been referred by a vet* Select option Yes No
Vets Name/Address & Telephone Number*
Is vet aware of insurance and recognises behavioural issue Select option Yes No N/A
Please select any of the below boxes if they apply to your dogs general behaviour
Aggression to People or Dogs
Please Select What Is Appropriate in Relation to Your Dog
S40 Have you self trained your dog in obedience Select option No Yes
S41 Have you consulted with the breeder regarding to your dogs problem(s) Select option No Yes
S42 Have you consulted with your veterinarian regarding the behaviour problem Select option No Yes
S43 Have you consulted a K9 behaviourist regarding your dog present problem(s) Select option No Yes
S44 Have you attended a dog training club with your dog for training Select option No Yes
S45 Have you watched any videos / books regarding to your dogs problem(s) Select option No Yes
House geography and general dog behaviour
S47 Does your dog have access to all rooms in your home Select option No Yes Sometimes
S48 Do you have a garden/patio or other outside play area for you dog Select option No Yes Sometimes
S49 Is your dog allowed to sleep on your bed Select option No Yes Sometimes
S50 Is your dog allowed to sleep in your bedroom Select option No Yes Sometimes
S51 Where does your dog sleep at night in the house
S52 How does the dog behave when you are leaving the house
S53 Is he / she destructive when left unattended or home alone Select option No Yes Sometimes
S54 Does he / she bark when left unattended or home alone Select option No Yes Sometimes
S55 Does he/she defecate or urinate when left unattended or home alone Select option No Yes Sometimes
Female owner first name
Male owner first name
Children under 16 years
Age
Gender Select option Male Female Other
Children under 16 years
Age
Gender Select option Male Female Other
Children under 16 years
Age
Gender Select option Male Female Other
Other persons/children living in house
S56 If 10 is deemed a perfect temperament and 0 as a poor what would you mark your dog taking into consideration its behaviour problem in question and that will be presented to the behaviourist.
If yes please write their name and age. If other please describe pet.
Please Select What Is Appropriate in Relation to Your Dog
S59 Does your dog paw or attempt to paw at you Select option No Yes Sometimes
S60 Does your dog lick yours/other peoples hands or face Select option No Yes Sometimes
S61 Does your dog mount people sexually Select option No Yes Sometimes
S62 Does your dog have access to toys, ropes etc in the home territory Select option No Yes Sometimes
Which Company is your insurance with
S63 Does your dog always greet you on your return home Select option No Yes Sometimes
S64 Does your dog get over hyper/ excited on your return home Select option No Yes Sometimes
S65 Is your dog indifferent to your return home or cannot be bothered Select option No Yes Sometimes
Activity Levels Physiological/Psychological - Please read all questions once and only answer on the second reading
S69 Does your dog have access to dog toys, balls, ropes etc in the home Select option No Yes Sometimes
S70 Will your dog bring toys back to you on command and release them Select option No Yes Sometimes
S71 Does your dog like playing with other dogs he meets Select option No Yes Sometimes
S72 During a walk with your dog do you play any game with/without a toy Select option No Yes Sometimes
Do you have a vet referral* Select option Yes No
S73 Does your dog generally ignore other dogs it encounters Select option No Yes Sometimes
S74 Do you or others play tug -o-war with your dog on ropes and other toys Select option No Yes Sometimes
S75 How long ( in total per day) is your dogs exercise periods Hours / Minutes
Punishment – do you practice the following
S76 Verbally punish the dog if you feel it is required or the dog has misbehaved Select option No Yes Sometimes
S77 Do you isolate the dog if you feel it has misbehaved Select option No Yes Sometimes
S78 Do you physically punish the dog if you feel it has misbehaved Select option No Yes Sometimes
Your specific view on the dog behaviour problem
S79 The problem is very serious and I would like to change it, but if it remains unchanged I will keep my dog (If you answer “yes” ignore questions S80 S81) Select option No Yes
S80 The problem is very serious and I would like to change it, but if it remains unchanged I will have to consider re-homing the dog Select option No Yes Not Applicable
S81 The problem is very serious and I would like to change it, but if it remains unchanged I will have to consider Euthanasing the dog Select option No Yes Not Applicable
Additional Behaviour Questions
S82 Is your dogs history known Select option No Yes
S83 From a rescue organisation Select option No Yes
S84 From kennel breeder Select option No Yes
S85 From a house breeder Select option No Yes
S86 Dog from another source
S87 Did you meet the dogs Sire & Dam (parent’s) Select option No Yes
S88 Has this dog had other owners Select option No Yes
S89 If yes - Why was the dog given up
S90 What age did you acquire the dog
S91 How old was your dog/puppy when it first socialised with other people outside the home
S92 Does the dog have any underlying medical conditions if so, list them
Veterinary/ Medical History
S93 When was the dog last at the vet and why (date) reason*
S94 Have you been advised of any underlying medical conditions*
Does the dog have any underlying medical conditions if so, list them
S95 If using pet insurance to cover consultation costs, have you asked veterinary surgeon for a copy of the dogs medical records to attach to the claim.* Select option Yes No N/A
S96 How many feeds a day do you give your dog:
Who feeds the dog?
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