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* 1. Owner details

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* 2. Patient details

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* 3. Referring veterinarian information

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* 4. Trainer information

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* 5. How did you find us?

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* 6. Please list the problems you are concerned about (we will deal with each of these in more detail later)

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* 7. Regarding problem one

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* 8. Regarding problem one how serious is the problem?

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* 9. Regarding problem two

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* 10. Regarding problem two how serious is the problem?

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* 11. Regarding problem three

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* 12. Regarding problem three how serious is the problem?

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* 13. People, please list the people living in your house starting with yourself

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* 14. Please list any other pets currently living in the household

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* 15. All these questions refer to the patient coming in for the consultation

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* 16. Does your dog like people? Tick all that apply

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* 17. Has your dog ever bitten anyone?

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* 18. If yes please give details

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* 19. Has your dog's personality changed over time? If so how?

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* 20. What rewards do you use for your dog (food,praise, ball etc.?)

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* 21. What is your dog's favourite pastime?

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* 22. Where is your pet when you are not at home?

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* 23. Where does your dog sleep at night?

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* 24. Is your dog crate trained

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* 25. What do you feed your dog?

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* 26. Do you ever feed bones?

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* 27. How does you dog react to

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* 28. In one or two words describe how you view your dog's personality

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* 29. Does you dog chase its tail excessively?

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* 30. Pace excessively?

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* 31. Try to escape when you aren't at home?

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* 32. Bark when you aren't at home?

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* 33. Show destructive behaviour when you aren't at home?

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* 34. Eat when you aren't at home?

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* 35. Toilet inside?

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* 36. Has your dog ever been the subject of a court order?

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* 37. Been issued a dangerous dog notification?

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* 38. What sort of collar or harness do you use to walk your dog?

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* 39. Have you attended dog training? If so briefly describe the training & how it went.

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* 40. Have you ever used deterrent devices such as shock or citronella collars or remote devices including spray bottles?

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* 41. If you answered 'yes' to the previous question please describe what you have used

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* 42. Do you use food toys/puzzles or other enrichment toys? If so which ones?

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* 43. Patient medical history, (please give details) does your dog have

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* 44. Anything else you would like to add about your pets behaviour?

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* 45. Can you please bring a rough sketch of the floor plan of your house and yard to the appointment to help devise a management strategy specific to your household?

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* 46. Which of these statement applies to you?

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* 47. During our consultation we will be discussing tolerance of risk. Do you understand that in treating behavioural problems there is always some element of risk? While treatment will address that risk it can never completely eliminate it.

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