DOGPSYCHE UK CANINE BEHAVIOUR CONSULTATION BLUEPRINT

Name Address Phone(s) Email Consult Date

GENERAL INFORMATION

Name Address

VETERINARY SURGEON DETAILS

Phone (s) Email / Website

Pets Name: Sex: Breed: Personality (Describe)

D.O.B. / Age: Neutered: Colour:

Age obtained: Age neutered: Breeder:

PET DETAILS

Age acquired: Previous homes (if known)

Reason for disposal:

Family Members: Sexes & Ages Other Animals & Details

HOME ENVIRONMENT

Family Members Interaction s with dog Descriptio n of dwelling Dogs Sleeping Area
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Daily Routine Weekend Routine

Food & Treats Feeding Times Who feeds Any allergies / food reactions Recent changes to diet

DIET

Top 5 Food Rewards Top 5 Toys Top 5 Games

TRAINING & REINFORCEMENT

Book(s):
Any Training? (%)

Training Class:

Private Instructor / Advice:

Breeder / Previous Owner:

Collar:
Types of Equipment Used Techniques used (%) Most Successful Least Successful Current Training Learning Ability Who Trains? Responses to... (Score 1-5 1=Poor 5=Excellent) Punishment s

Harness: Clicker: Other: Assertive, i.e. shouting: Other:

Lead: Headcollar: Reward-based: Corrective, i.e. smacking

Sit: DownStay: Recall (in public): Settle on command (with Physical Noise (rattle can etc)

Sit Stay: Recall (Indoors): Heelwork (onlead): details):

Down: Recall (garden): Heelwork(offlead):

Reaction: Reaction:
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Ultrasonic (highpitched sounds) Water Spray Verbal Physical (smacking) Time Out Smell Repellents Most Effective Least Effective Any Aggressive Reaction Reaction: Reaction: Reaction: Reaction: Reaction: Reaction:

Nail Trim: Brushing: Rubbing Belly: Patting Rear: Grab Collar: Rolled Over: Giving Pills: Hugs/Kisses: Handling by Vet / Strangers:

Ear Clean: Bathing: Patting Head: Patting Neck: Being Lifted: Teeth Exam: Giving Liquid Meds: Putting on collar / harness:

HANDLING RESPONSES

Primary Location Daily Frequency Housetrained ? Main Area Preferred Locations Learned Signals Housesoiling Most Likely Occasions While Family are Home? While Being Watched? Marking? Where? Describe Reaction to Housesoiling

Urinate: Defecate:

HOUSETRAINING

Yes / No (If Yes go to Medical Section) Outdoors? For Owner: From Owner: Frequency: Indoors? For Dog: From Dog: Urinate / Defecate:

Owner:

Dog:

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Elimination Habits Appetite Medical Conditions & Medication Suspected Ailments Last Lab Tests Last Vet Visit Excessive Stools Urine

MEDICAL Sleeping Area: Leaking/dribbling: Fear: Excitement: No Normal Voracious Decreased Picky Increased Fast

When?

Reason?

Urination? Drinking? Normal Constipated More Frequent Less Frequent Diarrhoea Normal Infrequent More Frequent Less Frequent More volume SEPARATION BEHAVIOUR

Is Dog Left? Duration (Average) Describe dogs actions just prior to departure Ever been kennelled at vet,boarded? Is dog ever alone outdoors? How long for? Any problems being left? Any difference when left at different times / durations? Does behaviour alter depending who is leaving? Describe owner / dogs
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reaction at homecoming Is dog okay in the car?

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Familiar Dogs on Property Familiar Dogs off Property New Dogs on Property New Dogs off Property Strangers on Property Strangers off Property Car Rides Thunderstorms / Fireworks Other Loud / Sudden Noise Children of Family New Children

REACTIVITY Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive N/A Calm Excited Indifferent Fearful Friendly Aggressive Inquisitive AGGRESSION SCREENING

Has dog ever displayed the following (to either dog or human): Threatening Displays Growling Bite Attempts Bites (Broken Skin) Bites (Marked Skin) Describe the most recent incident? When was it? How was this resolved? What prompted most recent aggression? What situations cause the aggression?

Petting / Handling / Restraint? Eating Chewing Toys / Stolen Stuff Waking up / being disturbed Is Aggression the Reason for Consultation? Injury Potential

Growling Bite Attempt Bite

No Aggression

Growling Bite Attempt Bite No Aggression Growling Bite Attempt Bite No Aggression Growling Bite Attempt Bite No Aggression

None / preventable Minimal Moderate

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Severe Aggression Towards Family - Describe

Aggression Towards Visitors - Describe

Aggression Towards Other Dogs - Describe

Aggression Outside Home Describe Most Likely Situation / Location for Aggression Owner Reaction to Aggression Dog Attitude before Aggression Dog Expression / Posture before Aggression Bold Protective Outgoing Fearful Inquisitive Playful Upright Cowered Tail Erect Tail Tucked Ears Back Ears Forward Stiffened Movement Hackles Retreating Moving Forward Moving Quickly Moving Slowly

Describe Primary Problems

PRIMARY PROBLEM

Severity When did Problems begin Age at onset Describe Most Recent Incident

Mild Moderate Severe Considering Euthanasia

Describe Previous Incidents

Describe 1st Incident

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Regularity of Problem Any Recent Change in Frequency or Severity Any Recent Changes in Routine Attempted Rectifications? Responses of Dog Techniques that worsened situation Techniques that improved situation Any Medication Response to Medication Dietary supplements or remedies Response to Dietary supplements or remedies

Jumps up at owners Jumps up at strangers Poor Recall Mouthing Selective Hearing Demanding Gets On Furniture Gets In Out of Bounds areas Exploratory Activity Level Sleep Coprophagia
faeces) (eating

MISCELLANEOUS

Normal Infrequent Increased Excessive Normal Inactive Restless Highly Active Excessive Normal Increased Decreased Restless Disturbed Own stools Other Dogs Cats Other Animals Eats non-food items (pica) From Bin From people From worktop From Children Chewing Digging Scratching Other
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Food Stealing Destructive

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Grooming Signs of Obsessive Compulsive Disorder Chasing Hunting Behaviours Sexual Habits Vocalisation Noise Sensitivity Stressful / Phobic Behaviour Shyness / Timidity (Nonaggressive) Any nonmentioned situations where dog is fearful / anxious

Normal Excessive Self-injurious Frantic Slow Tail Chasing / Licking Flank / limb sucking / licking Insect Chasing / Watching Star / Moon gazing Light watching / chasing Staring Other

Masturbation Mounting Roaming Barking Howling Whining Grumbling

Additional Problems / Comments

Please complete and return as soon as possible to: Jacqueline Bunn HNC ACFBA (S017) DogPsyche UK The Warren 5 Goodworth Road Wrotham
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Sevenoaks Kent TN15 7BJ Or Email: dogpsyche@btinternet.com

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