Consultation questionnaire

Client details

* Indicates required field

Name *

First

Last

Email *

Phone number *

Dogs details

Dogs name *

Dogs age *

Dogs breed *

Is the dog neutered? *

Yes No

How long have you owned the dog? (have you had it from a puppy or is it a rescue? if a rescue how old when you got it?) *

Veterinary details.

I may need to speak to your vet about this I need your consent to do this. ( without consent I will not be able to help you. ) *

Yes

Name of your vet practice *

Phone number of your vet *

Has your dog seen a vet for this problem? *

Yes No

Address of your vet *

Line 1

Line 2

City

State

Zip Code

Country

Details of the problem you require help with.

behaviour you need help with. (Please describe the behaviour, be as detailed as possible including dates of when it was first seen) *

When did this behaviour start? *

How old was the dog when the behaviour started? *

Has the behaviour changed since it first started? *

Further information.

How often do you walk your dog and where and how often do you walk it? *

Who walks your dog? *

You Other family member Dog walker

What does your dog eat? ( What brands of food please Include treats and brands.) *

Have you attended any training classes? (please give details) *

Does your dog have any health problems? *

Please provide more information about the health problems, include medications *

Details of any blood screens your dog has had *

Has your dog had a general anaesthetic? if yes when and what for *

Anything else you wish to tell me that you think may be relevant *

Consultation form

Client details

Dogs details

Veterinary details.

Details of the problem you require help with.

Further information.

If you haven't already done so please book your consultation here.