Dog Behaviour Private Consultation Form Step 1 of 6 16% Section One: Owner InformationName First Last Address Street Address City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home NumberCellular NumberEmail Are you 18 or older? Yes No Section Two: Dog's InformationDogs Name Dogs Breed Dogs Age Dog's Sex Is your cat spayed/neutered? Yes No Major issue you hope to address in this session:Was your dog adopted at CHS? Is this your first dog? Section 3: Background Information Complete this section only you if you did NOT adopt your dog from Calgary Humane Society.Where did you get your dog? If the background is known, why was the dog given up? What age was your dog when you adopted it? How long have you had the dog? Do you have any previous dog experience? Please explain.Why did you choose this particular breed? Why did you choose this particular dog? Section 4: Physical and Medical BackgroundWhat is the name of your veterinarian? Is your dog current on their vaccinations? Yes No Unsure Does your dog have any known medical problems? Yes No Is your dog on any type of medication? Yes No Does your dog have any food allergies? Yes No Has your dog experienced any of the following conditions? Deafness Ear Infections Allergies Seizures Thyroid Disease Heart Disease Other What is your dog's reaction going to the vet? Section 5: Consultation ObjectivesWhat would you most like to change about your dog’s behaviour? Name at least three things in order of importance. Add RemoveIs the dog housebroken? Yes No Is the dog crate-trained? Yes No What type of exercise does the dog receive? How often? Please describe a typical day in the life of your dog.What is your dog's favourite activity? What is your dog's least favourite activity? Section 6: Feeding and TreatsWhat type of food is your dog being fed? How many times a day is your dog being fed? Does your dog eat right away and finish the entire meal? Where is your dog fed? Who is typically nearby when they are fed? Who feeds the dog? Does the dog get “people food” and if so at what location? What types of treats, cookies or chew items does your dog get? How often?What is your dog's favourite treat? Second favourite? Section 7: Training and People InteractionHas your dog had any previous training? (If yes, describe who did the training, training methods, familiar cues, etc.)Does your dog respond to their name when called? What tricks does your dog know? How does the dog respond to your direction? Describe how you reprimand, correct, or punish your dog for unwanted behaviour.Give an example of the circumstances under which you might administer this reprimand/punishment.Describe how you reward your dog for good behaviour.What type of collar does your dog wear? Who lives in your dog’s household? (i.e. other pets, children, etc.) Who will be responsible for training this dog? Are family members able to handle your dog physically when... Trimming Nails Brushing/Grooming Off-Leash On-Leash Other How does your dog respond to strangers? Happy with a wagging tail Ears up, body stiff, hackles up Jumping Ears back and tail tucked Barking Does your dog urinate when approached by people? Yes No Other How does your dog react to stressful situations? (e.g., with strangers, when left alone, when confined) Wildly active Active Poised and assured Reserved Withdrawn Who administers “punishment” and how? Section 8: LogisticsWhere does the dog sleep? Is the dog allowed on the furniture? Yes No Where is the dog kept when no one is home? For what period of time, on average, is the dog left alone? What percentage of time does the dog spend indoors vs. out? Section 9: Dog-to-dog Interaction and AggressionHow does your dog react to other dogs? Please describe with as much detail as possible.Has your dog ever caused injury to another dog? Yes No If yes, did either dog require vet care? Please elaborate.Has your dog ever displayed aggression or made you feel uncomfortable about what they might do?If yes, what levels of aggression have you experienced with your dog and how many times? Excessive barking Lunging Growling Fixated staring Snap and miss Snaps, hits and lets go (caused bruises and/or scrapes) Single bite (one to four punctures) Bite, grab and shake (causes injury) Death Other Has your dog ever bitten another animal or a human? Yes No Section Ten: Behaviour Session SpecificsDescribe your dog's most troublesome behaviour and how often it occurs.When was the most recent incident? Has the frequency or intensity of the behaviour increased, decreased or stayed the same? Who is typically present when the behaviour occurs? When did the behaviour first manifest? Were there any changes in the household at the time you first noticed the behaviour?Under what specific circumstances does the behaviour typically occur? (i.e., specify time of day, location, before/after mealtime or playtime, etc.)What have you tried to alleviate this behaviour? What would you like your dog to do instead? What prompted you to seek help at this time? How much time and effort are you willing to spend on this issue? Are other members of the household willing to cooperate? Have you considered the following options should these issues not be solvable? Rehoming the dog with a friend, coworker, or relative? Returning the dog to the breeder Surrendering the dog to CHS Humane Euthanasia Is there anything else you’d like to share about your dog and their behaviour? Section 11: Final DetailsWhat is your availability? Please select possible days. Monday Tuesday Wednesday Thursday Friday Saturday Sunday What length of session are you most interested in? 60 minutes 90 minutes 120 minutes How did you hear about the classes offered at Calgary Humane Society? Website Social Media Yellow Pages Family/friend referral CHS Adoptions Department CHS PetGear Store Other I have read the following terms and: I agree I disagree Terms Private consultations are by appointment only. No walk-ins, please. Sessions take place at the Calgary Humane Society, located at 4455 - 110 Ave SE Payment must be made in advance of the appointment by Visa, MasterCard, debit, cash or cheque. Fees are non-refundable. In the event that a client is unable to keep an appointment, we require advance notice of two business days. Calgary Humane Society is happy to reschedule at the client's request. Call 403-723-6019 if you are going to be late/need to reschedule. Failure to keep an appointment without two business days advance notice may constitute forfeiture of fees rendered. Email