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DOG INFORMATION

Name

You can include Dog's Kennel Name here, too

Breed or Cross Breed

Reason for De-Sexing?

Please write N/A if not applicable

Dog's Age at Time of Arrival

Colour(s) and Defining Features

Weight (kg)

Body Condition Score

1 - Very thin. Obvious loss of muscle mass 2 - 3 - Thin. No fat on ribs or lower back, some muscle loss 4 5 - Ideal. Ribs, spine and hip bones are easily felt and may be visible. A waist and ab tuck are visible when looked at from above and side. Fat can be felt around ribs, spine & hip bones 6 7 - Overweight. Ribs, spine & hips bones are not visible & difficult to feel. Excess fat is felt around ribs, spine & hip bones. Waist and ab tuck are minimal or absent. 8 9 - Obesity. Thick layer of fat. Waist and ab distended. Prominent fat deposits over lower spine, neck & chest

Food Motivation Score

Food Motivation - Extra Notes

Describe your dog's socialisation period (under 18 weeks)

- Socialisation with Sights, sounds, textures, weathers, times of day, people, objects, animal husbandry, other dogs, other animals. - Puppy's reaction to new things - Any adverse experiences (aggressive dogs, nasty people, long travel, was on street, starvation) - Any traumatic medical intervention (operations, vet stays, life-threatening illnesses, vet intervention perceived as scary)

HOUSEHOLD INFORMATION

People living in household

Name, Age, relationship to main guardian

Other people in regular contact with the dog

Walker, daycare, relatives, friends, social support

Type of Property

ACQUISITION INFORMATION

Describe Dog's previous situation if known

Was your dog rescued/ adopted? Do you have any information on their life before you? Type N/A if not applicable

Why did you want a dog?

MEDICAL HISTORY

List any major illnesses/surgeries (dates) List ALL medications/treatments your dog is currently receiving, including heartworm, flea preventative, dietary supplements, herbal/homeopathic treatments:

If yes, what was the outcome?

Type N/A if not applicable

Allergy Signs & Test Results - note below

Write "none" if you have not observed any signs

DAILY ACTIVITIES & ROUTINE

Brand, Flavour and Type of Food

e.g. AATU, Duck, Dry - kibble

Extra Supplements, Additives, Treats

write 'none' if not applicable

Meals Per Day

Where does your dog sleep at night?

Does Dog have a safe/ their own location to sleep

Especially important in multi-dog household. Can they find somewhere warm, cool, out of breeze?

If disturbed whilst sleeping, what is your dog's reaction?

Describe your dog's daytime sleep

How long do they sleep for? Do they enter deep sleep? Do they dream? Are they easily startled? Where do they settle best?

Do you have any concerns or worries about daycare?

This can be about the daycare itself, or your dog's behaviour whilst and after they are there

EXERCISE

If you answered "No", please include more information

Who takes your Dog for Lead Walks?

Does your dog walker use aversive methods?

Other

Describe your Dog's Behaviour on Group Walks

If no, what were the deciding factors in choosing to keep your dog on lead?

How Often Is Your Dog Off-Lead? With Who? Where?

EQUIPMENT

ALONE TIME

Total hours Dog is left alone per day

On average

Maximum hours in one stretch left without human

Other/ More Info

DAY IN THE LIFE

Describe a typical 24 hour day in your dog's life, starting with when and where the dog wakes up in the morning. Include feeding, exercise and play times. If behavior problems occur at particular times of the day include that information.

TRAINING

For How Long?

Level Achieved

Which human trained the dog?

Other/ Extra Info

Can they respond when out and about?

How do you respond when your Dog doesn't react to a cue?

On a scale of 0-10, how responsive is your dog to recall

0 - Never responds.

Does Dog enjoy training? How can you tell?

BEHAVIOURAL SCREENING

Bite Information

If yes, please describe: On how many separate occasions has this happened Dog's age The situation Age of human toys involved food involved warning signs

If reported - what was the outcome?

PRIMARY PROBLEMS

Short Description of Problems

Describe the very first incident of this problem. Try to remember the earliest occurrence of the problem, even if it wasn't as serious as it is now. For instance, if your dog is aggressive to people, describe the first time they growled or barked at someone. Or if your dog pulls on the lead, think back to if this started at a certain point. Include where the incident occurred, who else (human and animal) was present, what happened just before the incident, how everyone reacted. Date of event & Dog’s age (Approximate date/age is o.k.)

Describe per instructions above the most recent incident Date of event & Dog's age

Describe per instructions above at least one other incident you feel illustrates the problem behaviour (if you would like to describe other incidents please do so on a separate page) Date of event & Dog's age

If you noticed any changes in your dog's body language or facial expression before, during or after the incidents please describe.

What would you like to see as an outcome of working together?

Trainer Notes

What have you done to try to manage, prevent and train out of this problem?

Training, internet help, P+, muzzle, lead etc

Client's Perception: How do you feel about the situation?

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