Full day behavioural assessment application

FULL DAY BEHAVIOURAL ASSESSMENT AND TREATMENT PROGRAM APPLICATION

Please complete the following questionnaire at least 7 days prior to your appointment.

It will take approximately 30 minutes. Try to give as much detail as you can when asked.

Please note appointments CANNOT PROCEED without a completed questionnaire.

1. Your Name

2. Your Email Address

3. Your Phone Number

4. Please describe in a few words, the nature of the behaviour(s) causing concern? (We will ask for specific details later) and how it is impacting on you and others.

5. Briefly describe what you hope to achieve for your dog with our support.

6. Your Dog's Name

7. Your Dog's Age

Date Of Birth

8. Age When Obtained

9. Your Dog's Breed

10. Your Dog's Sex

11. Your Dog's Neuter Status

13. Is Your Dog Currently On Any on any Medications Or Supplements (Such As Dietary Supplements Or Herbal Products)?

Yes No

13b. If Yes, Please Provide Details Below

14. Has Your Dog Been On Medication For Their Behaviour In The Past?

Yes No

14b. If Yes, Please Provide Details Below

15. Please Describe Your Dog's Medical History

16. What Previous Experience Do You Have With Dogs?

17. Is Your Dog Crate Trained?

Yes No

18b. If You Selected Other, Please Provide Details

19. How Long Has The Behaviour Been Present And How Old Was Your Dog When It Began?

20. Can You Identify Any Specific Event Or Trigger Which Started The Behaviour Of Concern?

21. Where And With Whom / In What Situations Does It Occur Now?

22. Is The Behaviour Better Or Worse In Certain Circumstances Or With Certain Individuals, Or Have You Noticed A Particular Pattern To The Behaviour?

23. How Frequently Do You Encounter The Behaviour? (Times Per Day, Month Or Year)

24. If Your Dog Displays Aggressive Behaviour, Have They Bitten You / Another Person / Another Animal?

24b. If You Selected Other, Please Provide Details.

25. What Has Been Done To Correct The Behaviour?

26. Has Your Dog Ever Redirected On To You In Situations Where You Attempted To Correct Behaviour Or They Were Unable To Get Their Own Way? (Redirection Means Your Dog May Have Attempted To / Snapped / Bit The Lead / You / Jumped Up At You)

Yes No

27. Any Other Details Relating To Each Behaviour Of Concern That You Would Like To Share With Us?

28. Briefly Describe The Property Your Dog Lives At And The Degree Of Access Your Dog Has To This.

29. Please List Any Other Household Pets.

30. Please List Names And Ages Of Other Family Members Who Live At Home And How You Would Describe The Relationship Of Each Family Member To Your Dog.

31. What Training Have You Done (In Class Or At Home) With Your Dog? Did You Follow A Course, Used Your Previous Experience, Consulted A Professional, Took Your Dog To Classes? How Did That Training Go?

32. What Obedience Commands Does Your Dog Understand?

33. Is Your Dog More Obedient In Different Places Or With Specific Individuals?

34. What Do You Do When Your Dog Behaves In A Way You Do Like?

35. Please List Below The Things Your Dog Is Most Fond Of / Finds Motivating.

36. What Do You Feed Your Dog?

37. How Would You Describe Your Dog's Appetite And How Quickly They Eat? Are They Food / Treats Motivated?

38. Does Your Dog Have Any Allergies?

39. Does Your Dog Show Any Of The Following?

Appetite for non-food items like stones, plaster Exessive licking of walls, hands, or other surfaces Other unexpected behaviours related to feeding Protective over food None related to feeding

40. Please Rate Your Dog's Personality On A Score Of 1-10 For Each Of The Following, Where 1 = Stressed / Anxious / Fearful And 10 = Friendly / Relaxed:

Around people they know (including children)

Around people they don't know (including children)

Around dogs they know

Around dogs they don't know

In low distraction environments (e.g. at home, back garden, quiet park)

In high distraction environments (e.g. when other people / dogs are around, in cafes, high street)

42. Does Any Aspect Of Your Dog's Behaviour Change When Free Compared To When On A Lead?

43. Is Your Dog Protective Over Any Part Of Their Body?

44. Does Your Dog Have Any Known Fears Or Things They Dislike?

45. What Are The Feelings Of Each Family Member About Your Dog's Current Behaviour?

46. Under What Circumstances Would You Consider Euthanasia?

47. Please Describe A Typical 24 Hours In The Life Of Your Dog

48. Does This Routine Change At Any Time? If Yes, Please Specify How.

49. Do You Walk Your Dog? Does Any Other Member Of Your Family / Household Walk Your Dog?

50. Please Indicate The Length Of Walks And What The Walks Look Like.

51. Please Indicate How Much Time Is Spent Off Lead Each Walk.

52. What Extracurricular Activities Do You Do With Your Dog?

53. Please Indicate Which Of The Following Aggressive Incidents Have Occured.

Vocalised (e.g. growl / snarl) but never bitten Snapped but not made contact with skin Bitten (made contact) but not broken skin Single bite with broken skin (puncture wound) Bitten with multiple puncture wounds on a single occasion Bite with removal of skin with some underlying tissue Multiple bites with puncture wounds on a single occasion None of the above

If You Selected None Of The Above, Please Skip The Following Questions And Submit The Questionnaire. Otherwise, Please Answer All Of The Following:

54. Describe The Most Recent Incident And The Circumstances In Which It Occured.

55. Where Was Your Dog?

56. Where Was Everyone In Relation To Your Dog?

57. What Was Everyone Doing Before The Incident?

58. What Did Your Dog Do Exactly And What Did They Look Like Just Before And After The Event?

59. Were You Aware Of Any Warning Signs Before The Incident?

60. What Was The Reaction Of The Victim?

61. How Did Your Dog Respond to This Reaction?

62. If There Was A Bite Wound, Where Was It Located On The Body And What Kind Of Wound Was It?

FULL DAY BEHAVIOURAL ASSESSMENT AND TREATMENT PROGRAM APPLICATION

Church Broughton, Derbyshire, UK

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FULL DAY BEHAVIOURAL ASSESSMENT AND TREATMENT PROGRAM​ APPLICATION

FULL DAY BEHAVIOURAL ASSESSMENT AND TREATMENT PROGRAM APPLICATION