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4957 7106
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Home
For Pet Owners
For Vets
Emergency
About
Careers
Fees
Events
Meet the Team
Our Giving
Acknowledgement of Country
Services
After Hours Care
Blood Donation
Imaging
Ophthalmology
Rehabilitation
Surgery
Veterinary Behaviour
Resources
Contact
Search
Home
For Pet Owners
For Vets
Emergency
About
Careers
Fees
Events
Meet the Team
Our Giving
Acknowledgement of Country
Services
After Hours Care
Blood Donation
Imaging
Ophthalmology
Rehabilitation
Surgery
Veterinary Behaviour
Resources
Contact
Home
For Pet Owners
For Vets
Emergency
About
Careers
Fees
Events
Meet the Team
Our Giving
Acknowledgement of Country
Services
After Hours Care
Blood Donation
Imaging
Ophthalmology
Rehabilitation
Surgery
Veterinary Behaviour
Resources
Contact
Elementor #17992
Family Details
This field is hidden when viewing the form
ReferenceID
Name
(Required)
First
Last
Who else lives in your home with you and your pet?
(Required)
Please include their ages and how they interact with your dog (e.g. partner, child, housemate).
Are there any other pets that live in the household with the referred pet?
Please include species, breed, age, sex/neuter status, relationship to referred pet and when they were acquired.
Your Pet's Details
Pet's Name
(Required)
Breed
(Required)
Species
(Required)
Canine
Feline
DOB/Age
(Required)
Approximate Weight
Sex
(Required)
Male
Male Neutered
Female
Female Neutered
Date of Neuter
Reason for Neutering
For example: medical recommendation, behaviour management, age, or routine desexing.
Background Information
What age was your pet when you first brought it home?
How did you acquire your pet?
Examples include: adopted through rescue, breeder, friend, etc.
What made you decide to bring a pet into your life?
Why did you choose this particular pet?
Did you meet/view your pet's parents? If so, how would you describe their personalities?
Did your pet attend puppy preschool or any other formal training?
Yes
No
Please provide details of the types training your pet has participated in:
Have you moved house since acquiring your pet?
Yes
No
A Day in the Life
What does your pet eat and how is it fed?
Examples include: feeding from a bowl, enrichment toy, scatter feeding
What would you consider your pet's favourite treats/food?
Would you describe your pet as a fussy or picky eater
Yes
No
Does your pet have any allergies? If so, please provide information below:
How often and for how long does your pet usually get walked or exercised?
We understand that some pets can’t be walked due to behaviour or other factors - that’s completely okay. This question just helps us get a clear picture.
What equipment do you use to walk or exercise your pet?
Where does your pet sleep during the night?
Approximately how long does your dog sleep overnight, and do they wake at all during the night?
If known, does your pet nap during the day? If so, where do they like to sleep and for how long?
Does your pet have access to outside during the day or it kept indoors?
Yes, my pet can go outside.
No, it is strictly an indoor pet.
Medical Information
Does your pet have any known medical conditions? If so, please list them here:
Is your pet currently on any medications or supplements?
Please provide the supplment/medication name, timing of dose and include the approximate start date.
Has your pet previously been prescribed any medications or supplements specifically for behaviour?
Yes
No
Has your pet ever had seizures?
Yes
No
Digestive habits: Please provide information of number of stools per day. Please include frequency of diarrhoea or vomiting
Please provide any other relevant medical history here:
Behaviour
Describe the behavioural issues you are concerned about:
When did the behaviour concerns begin?
Describe the FIRST incident (include details such as time, place, those involved and what happened):
Describe the MOST RECENT incident (include details such as time, place, those involved and what happened):
What have you tried so far to correct/change the behaviour?
Have you worked with any trainers or behaviourists in the past?
If acquired as a pup, how would you describe them at that time?
Not acquired as a pup
Outgoing
Social
Adventurous
Shy
Timid
Fearful
Nippy
Playful
Never slept
If acquired as a kitten, how would you describe them at that time?
Not acquired as a kitten
Outgoing
Social
Adventurous
Shy
Timid
Fearful
Nippy
Playful
Never slept
Interactions with People
How does your pet respond to familiar visitors at home?
How does your pet respond to unfamiliar visitors at home?
How does your dog respond to people on walks?
Has your pet ever bitten a person?
Yes
No
If your pet has displayed aggression, how do you handle these situations and how does your pet respond/react to you?
(Required)
Interactions with Dogs
Please describe their behaviour, both on and off the lead, when they have encountered another dog:
Has your pet ever injured/bitten another dog?
Yes
No
Home & Routine
Describe your household’s typical daily routine (wake, feed, walk, play, leave/return).
Please provide as much detail as possible.
How often and for how long is your pet left home alone?
What does your pet do when left home alone?
Does your cat use a litter tray or toilet outside?
Please provide details on how often your pet toilets.
Is your pet toilet-trained? Do they currently urinate and defecate inside?
How does your cat react to loud noises?
What is your pet's favourite game/activities?
Do you engage in any rough play? If yes, describe what happens when the play stops:
Does your dog guard items such as food or toys?
Grooming & Travel
Does your pet visit a professional groomer? How do they behave there?
Do you do any grooming at home? If yes, how do they respond?
Does your pet enjoy travelling in the car?
Upload
Please provide a video of your pet displaying the behaviour you have described.
Drop files here or
Select files
Max. file size: 300 MB, Max. files: 15.
