Canine Behavioural History Form

Dr Hannah Donovan BSc (Hons) BVM&S MVetSci MSc MRCVS CCAB
RCVS Advanced Practitioner in Companion Animal Behaviour

Canine Behavioural Form

"*" indicates required fields

Client Details

Client Name*

First Last

Address*

Street Address Address Line 2 City County Post Code

Email*

Phone*

Please list the names, ages and occupations of each member of the household:

Name

Age

Gender

Occupation

Relationship with dog in question

Patient Details

Dog Name*

Dog Breed*

Age (D.O.B)*

Gender*

Is the animal neutered?*

Entire

Neutered

Weight (kg)

Age obtained*

Date obtained*

Source (obtained from)*

Reason for obtaining*

Has he/she ever been used for breeding?*

How would you describe your dog's personality?*

Have you owned dogs previously?*

Have you owned other pets previously?*

Please list any current household pets

Name

Type/Breed

Age

Gender (neuter status)

Relationship with dog in question

With which insurance company is your pet insured? Leave blank if your pet is not insured.

Medical History

Please give a brief description of your dog's medical history*

Which vet practice is your dog registered with?*

Vaccination status*

Date of last worming:*

Is your dog on any regular medication?*

Has your dog ever been on medication for his/her behaviour? If so, please describe the drug, dose and date(s)

Early History

Please describe, if known, what your dog’s early environment was like, including; litter size, early experiences, dam and sire personalities, if reared indoors/outdoors, early interactions with people, etc.

Is your dog house-trained? If so, how did you teach house-training?

Is your dog crate-trained? If so, how did you teach crate-training?

Did or does your dog attend any training or socialisation classes? If so, please describe

How well do you think your dog learns?

What is your dog fed? How much, how often and where?*

Where does your dog sleep?*

What is your dog’s daily routine (including; sleeping, resting, playing, eating, exercising, home alone, etc)?*

How is your dog when left alone?*

What is your dog's usual reaction to visitors, strangers outside and other animals?*

What is the current problem?*

When was the first incident? Please describe it in detail*

How old was your dog at the first incident?*

How often does it occur/how long has it been occurring?*

Please describe two more occasions and what you think may have been happening at the time*

What do you think the triggers are for these behavioural issues? Why do you think your dog displays this behaviour?*

Have there been previous attempts to rectify the situation? If so, what methods have been used?

Has any form of punishment been used?*

Does your dog display any other unwanted behaviours?*

How does your dog’s behaviour make you feel?*

What outcome would you ideally achieve from a referral behavioural consultation?*

Realistically, how many hours do you feel you spend directly with your dog per week, for example, during play, training, exercising, relaxing together, quality time together?*

Has euthanasia been considered for your dog?*

Attach any additional information such as photos, videos, floorplans, relevant reports, timelines, etc.

Drop files here or

Accepted file types: pdf, docx, doc, rtf, txt, xml, Max. file size: 64 MB.

Do you give permission for Donovan Veterinary Behaviour Practice to use suitable photos and videos of your animal in our printed and online publicity, and possibly to be used as examples in case studies for educational purposes?

Permission given

Our experienced clinical animal behaviourists work with our in-house veterinary behaviourists on each of their cases. If deemed necessary, this case may also be discussed with our in-house internal medicine specialist.*

I have read and understood

Do you agree to the Terms and Conditions?*

I have read and agree to the Terms and Conditions