Existing Clients Only - Behavioural Intake Form

Tell us about your dog!

Thank you for booking a behavioural service with Bespoke Behaviours. Please complete the below form as fully as you can to provide valuable information about your dog so that we are aware of as much about your dog as possible before we even meet. We appreciate that the form is very detailed but this will allow us to work together most effectively and efficiently.

Please be honest with the information you provide. There is no judgement whatsoever, we just need the full picture to understand your dog better and to establish the most appropriate way to work with them.

If you don't know an answer to a question, please say so. If a question is not relevant to your dog, please leave it blank or put N/A.

Your name

Phone

Address

Where did you hear about Bespoke Behaviours?

Dog's name

Dog's date of birth / approximate age

Dog's breed

When did you get your dog?

Where did you get your dog?

Breeder

Rescue

Private rehome (eg online ad)

Other

Please give details of rescue / other AND any known history of your dog prior to you adopting them (eg previous homes / incidents / traumas)

Is the dog insured? If so, who with?

Is your dog neutered / spayed, if so, how old was the dog when it happened?

Vet details:

Do I have permission to contact your Vet if required, for example to request a clinical history?

Has your dog seen a vet in the last 12 months? Please give details

Does your dog have any current medical conditions? Please give details

Has your dog had any previous medical conditions / illnesses/ injuries which are now resolved? Please give details

Who lives in the household (include other humans and animals)? Please include ages for any children

Has your dog ever done any formal training or behaviour interventions? (eg puppy classes / trainer / behaviourist). Please give details of who you worked with and their methods

Please explain the issues you are currently having with your dog's behaviours

How long have these issues been happening? Did they coincide with any incidents or changes to their environment? Are there any obvious triggers for the behaviours?

What have you tried so far to change the behaviours?

How do these behavioural issues affect you / the household members? How do they make you feel?

Have you spoken to your vet about the behavioural issues? If so, what did they advise?

What does your dog eat? Please include dog food brand(s) and how often they are fed

Any issues around feeding / eating / appetite / stools? Please include any food allergies

Who generally feeds and walks your dog?

Please describe your dog's daily routine including where they sleep overnight

What methods of training have been used so far to attempt to change behaviours either now or in the past with this dog?

Please elaborate on training methods attempted if you would like to add further information or aren't sure of the category of methods used

How would you describe your dog in general? (eg relaxed, happy, fearful, nervous, anxious, sociable etc)

Please give information on any ticked options (other than none) and the result of the intervention

Does your dog sleep during the day at home? For how long? What is the quality of the sleep (eg deep dreaming / alert and awake with any movement in the environment)

Has your dog ever shown aggression to another dog or animal (excessive barking / lunging / growling / baring teeth / biting)? Please provide as much information as possible

Has your dog ever been attacked by another dog? Please provide as much detail as possible including any effects on their ongoing behaviour after the incident(s)

Has your dog ever shown aggression or threatening behaviour towards people? Please give as much detail as possible including genders, ages, movements and locations of the people at the time

If your dog has ever bitten a person or dog, please tick the severity of the worst bite

The dog has air snapped or nipped but not caused any damage

The dog has scratched the skin with their teeth, or caused the skin to bleed but no puncture wound. No medical treatment needed

The dog has bitten and caused a small puncture wound, but no medical treatment needed

The dog has bitten heavily with clear puncture wound - but a single bite. Medical treatment may have been needed

The dog has bitten heavily with clear puncture wounds, and delivered several bites. Medical treatment needed

My dog has never bitten a person or dog

Other

How does your dog react to visitors to the home?

Does your dog have doggy friends that they get along with?

Please list things that your dog loves

Please list things that your dog hates

Please give as much information as possible

What are you hoping to achieve from a behavioural intervention?

Any other information

Please tick this box to confirm that you have read AND accept the Terms and Conditions

Yes, I have read and agree to the Terms and Conditions

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