NUTRITION & BEHAVIOURAL CONSULTATION SERVICES

By answering the questions below you will help me understand your canine problem and design a personalized solution for you.

(Please note that my services do not include aggression behaviour modification.)

YOU CAN CONTACT ME IN TORONTO BY:

  • Phone: 416-635-1382
  • Email: nancy@devotedtodogs.ca


Please Fill Out And Submit The Questionnaire Below And I Will Contact You By Email And/Or Phone

  • The only required information is First and Last Name, Phone Number, and Email Address.
  • The SUBMIT Button is at the end of the Questionnaire


YOU

First Name*:     Last Name*:
Full Street Address:
Phone Number*:     Email Address*:

YOUR DOG

Dog's Name:     Dog's Breed:     Dog's Sex:  (M/F)   
Describe The Colour Of Your Dog's Coat:
How Old Was Your Dog When Obtained?     Current Age:     Current Weight:

MEDICAL

Is Your Dog Spayed or Neutered?  (Y/N)         At What Age Was This Procedure Done?
Were There Any Behavioural Changes After Neutering?

Date Of Last Physical Exam?     Were There Any Problems?
Any Current Medications (with doses):

Describe your dog's behaviour in the veterinary office and during an examination:


THE DOG'S LIFE

How Many On-Leash Walks A Day?     How Long Do The Walks Last?
Where Do The Walks Take Place?
Does your dog have any restrictions within the house?

How Much Time Per Week Is Spent Playing Actively With Other Animals?
How Much Time Per Week Is Spent Playing Actively With The Owner?
What Type Of Play Activities?

Have You Ever Attended Obedience Classes With Your Dog?  (Y/N)   

How does your dog interact with family members?
How does your dog react to strangers?

Do you have other animals in your household? Please list their number, species, breed, age, sex and whether or not they are neutered. Were any of these animals living in the house prior to acquiring your present dog?



Check All The Behaviours That Your Dog Will Do Willingly:
SIT
STAY
DOWN
HEEL
COME
FETCH
DO TRICKS
STAND FOR GROOMING or PHYSICAL EXAMS

Check All The Activities That Your Dog Works Well For (is motivated by):
FOOD
PRAISE
PETTING
BALL/FRISBIE/RETRIEVAL GAME
NO REWARD

FEEDING

What Type Of Food Do You Feed?
How Often Do You Feed?     How Much Do You Feed?
Other Foods?  (Treats, Bones, Table Scraps, etc.)   
Does Your Dog Have Any Food Sensitivities Or Allergies?
Has Your Vet Recommended Any Specific Food To Remove Or Add?
What Supplements (if any) Are Being Used?

BEHAVIOUR


Describe the specific behaviour problem you wish to work on:



What was the age of onset for this behavior?     How frequent is this behavior?

Describe the methods you have used to try to stop this behavior:



Can the dog be interrupted when engaged in this behavior?
    YES
    NO
    SOMETIMES

Do you know if the dog's parents or siblings engaged in similar or other abnormal behaviors?  (Y/N)   

Please give a detailed description of the last time this behaviour occurred





If your dog exhibits problem behaviour when left alone or appears excessively anxious as you prepare to leave, please complete the following questions.

Was your dog acquired from a shelter or pound?
    YES
    NO
    DON'T KNOW

Was your dog acquired from a pet store?
    YES
    NO
    DON'T KNOW

Has your dog had multiple owners in his/her life?
    YES
    NO
    DON'T KNOW

Was your puppy an orphan or hand raised?
    YES
    NO
    DON'T KNOW

Was your dog the single puppy in a litter?
    YES
    NO
    DON'T KNOW

Does your dog follow you around the house?
    YES
    NO
    DON'T KNOW

Does your dog become anxious when you put on your coat and shoes?
    YES
    NO
    DON'T KNOW

Does your dog become aggressive when you leave?
    YES
    NO
    DON'T KNOW

Does your dog bark or whine excessively within 30 minutes of your departure?
    YES
    NO
    DON'T KNOW

After you leave does your dog's acitivity actually decrease?
    YES
    NO
    DON'T KNOW

After you leave does your dog appear depressed?
    YES
    NO
    DON'T KNOW

After you leave does your dog have a loss of appetite?
    YES
    NO
    DON'T KNOW

Only in your absence does your dog destroy property?
    YES
    NO
    DON'T KNOW

Only in your absence does your dog urinate or deficate in your home?
    YES
    NO
    DON'T KNOW

Does your dog regularly have diarrhea, vomit or lick excessively in your absence?
    YES
    NO
    DON'T KNOW

Does your dog exhibit an execessive greeting on your return (jumping, hyperactivity, barking more than 2-3 minutes)?
    YES
    NO
    DON'T KNOW