Home Visit Form

Home Visit Form

Payment will be required to confirm the appointment. Payment details will be sent with time and date options once the form has been received.
Full Name*

First NameLast Name
MOBILE Phone Number*
E Mail address*
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip CodeCountry
Where did you find us
Please tick to say you know the cost of the appointment (see website)

yes
Dogs Name
Breed
Age when aquired
Age now
From where

Home breederCommercial breeder ie: Classified advert; pet4homes, Little rascals etcProfessional Low volume breederA friendRescue centreother
Sex

MaleFemale
Name of your Vet
Is your dog neutered/ castrate/ spay

yesno
Date of neutering/ castrate/ spay
Is this your first dog you have owned

yesno
Do you have other dogs and how many

123more
Please give brief description of other dogs. Breed, sex, neutered, age
Please describe the issues concerning you*
Have you attended training classes

yes
When did the problem begin
Which classes did you attend, for how long
Does the unwanted behaviour occur in any particular situation or with a particular person
Is your dog on any medication. Please give details
Who else lives in the house with the dog
Describe how your dog greets strangers who enter your house/ property*
How did/ do you deal with mouthing /nipping
In normal circumstances does your dog act differently with different people, for instance your partner.

yesno
In what way
Would you describe your dog as playful

yesnosometimes
Who initiates play

youyour dog
How do you get your dog to give up items they have in their mouth
Does your dog have favorite toys, describe how he/she plays with it/them
How do you reward good behaviour
How do you stop / correct unwanted behaviour
Outdoor ON lead behaviour

Responds well to youResponds but easily distractedHighly distractedShyFriendlyAggressive towards other dogs/people
Outdoor OFF lead behaviour

Responds well to youResponds but easily distractedHighly distractedShyFreindlyAggressive towards other dogs/people
If shy or aggressive briefly describe how this looks/ appears/ manifests itself
If Shy or Aggressive at what distance from the other dog/person does your dog display these behaviours. For example 3 metres away or perhaps 50 metres away
Exercise

upto 1 hour dailyover 2 hours dailyNo regular routine
When does your dog get their main meal

twice dailymorning onlyevening onlyaccess all day
Does your dog take food / treats

Only IndoorsOutdoors No distractionOutdoors with distraction
What food do you give your for the mainmeal. eg; dry, canned or other
Food given to your dog throughout an average day, NOT including main meals

Human foodPet store treats
Will your dog allow anyone to approach while eating

yesno. body stiffens and stops eatingno. growls
Does your dog pull on the lead

badlysometimesno
What does your dog do most of the time at home.
How long is your dog left alone on average

upto 2 hours2 - 4 hoursnever left alone
Do you know what your dog does when you are not at home, if yes describe
Does your dog get off lead time

oftensometimesnot oftennever
Has your dog ever been attacked/bitten by another dog

yesno
If yes, how did your dog react
Does your dog enjoy being handled / groomed / petted

yesno
Can you take items off your dog / out of his mouth

yesno
Has your dog ever growled, lunged , snapped or bitten a family member*

bittensnappedlungedgrowledno
Has your dog ever growled, lunged, snapped or bitten a stranger/other person*

bittensnappedlungedgrowledno
If yes to either of the above questions, please describe the situation / context*
If bitten, describe injury. Tear, puncture, bruising etc
Has your dog ever snapped or bitten another dog

yesno
If bitten, describe injury. Tear, puncture, bruising etc
What are your expectations from this appointment*
Appointment time/day options. Please tick two options. Unfortunately chosen days cannot be guaranteed.

MondayTuesdayThursdayFridaySaturday
If necessary, appointments can be rescheduled within 3 weeks of the original date otherwise a refund of 30.00 is given for cancelled appointments.*

Agree
Payment will be required to confirm the appointment. A message will be sent with BACS payment details on receipt of this form.*

Agree
Thank you for answering the above questions

I will be in touch shortly.
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