Dog's Details
  1. (Required*)
  2. (Required*)
  3. (Required*)
  4. (Required*)
  5. Gender
  6. Neutered
Owner's Details
  1. (Required*)
  2. (Required*)
  3. (valid email required)
  4. (Required*)
  5. (Required*)
  6. (Required*)
  7. (Required*)
General Behaviour Questions
  1. (Required*)
Your Dogs Problems
  1. Select All Applicable To Your Dog
  2. Aggression to People or Dogs
  3. Have you self trained your dog in obedience
  4. Have you consulted with the breeder regarding your dogs problem(s)
  5. Have you consulted with your vet regarding the behaviour problem(s)
  6. Prior to this, have you consulted a behaviourist regarding your dogs present problem(s)
  7. Have you attended a dog training club with your dog
  8. Have you watched any audio or read books regarding your dogs problem(s)
  9. (Required*)
  10. (Required*)
  11. Does your dog have access to a garden/patio or other outside play area
  12. (Required*)
  13. (Required*)
  14. (Required*)
  15. (Required*)
  16. (Required*)
  17. (Required*)
  18. Number of people living in the house
  19. (Required*)
  20. (Required*)
  21. Do You Have Children less than 16 years of age
  22. If 10 is to be deemed a perfect temperament and 0 is worst what would you mark your dog taking into consideration its MAIN behaviour problem in question and that will be presented to the behaviourist today. This question does not relate to other good or bad behaviours and relates only to the primary problem.
  23. (Required*)
Attention Seeking Behaviour
  1. (Required*)
  2. (Required*)
  3. (Required*)
  4. (Required*)
  5. (Required*)
  6. (Required*)
Activity Levels Physiological – Psychological
  1. Please read all questions in this section once and only answer on the second reading
  2. (Required*)
  3. (Required*)
  4. (Required*)
  5. (Required*)
  6. (Required*)
  7. (Required*)
  8. (Required*)
  9. (Required*)
Punishment and Discipline
  1. Do you practice the following:
  2. (Required*)
  3. (Required*)
  4. (Required*)
Your Specific View on Your Dog Behaviour
  1. The problem is very serious, I would like to change it, but if it remains unchanged I will keep my dog. (If you answer yes to this question ignore the next question)
  2. (Required*)
Canine Behaviour Centre Section
  1. (Required*)
  2. Did you meet the Dogs Sire & Dam
  3. Did you get your dog from a rescue organisation
  4. Has this dog had other previous owners
  5. Did you get your dog from a kennel breeder
  6. (Required*)
  7. (Required*)
  8. (Required*)
Disclaimer
  1. I have completed this form to the best of my ability and in the capacity of owner of the dog detailed herein. © 2012 Do Behave
  2. For Office Use Only
 

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