• Canine Behaviour Questionnaire

    Completing this form is part of your assessment
  • Thank you for being here to complete your form, this is the first step in making changes. 

    BOOKING POINT: This can be accessed once you have completed this form. 

    • VIP: Please ensure you read this entire section before proceeding 
    • Thank you for starting your behaviour questionnaire. Completing it is step 1 of 4, and you stay in control of every step.

      YOUR 4 STEPS
      1. Complete this questionnaire
      2. Ask your vet to complete the veterinary referral form online
      3. Book your programme
      4. Schedule your appointments: a confirmation email is sent once your programme is booked, and it explains how to schedule both your behaviour assessment and your follow-up appointments

      BEFORE YOU BEGIN
      - Allow plenty of time. A computer or tablet works better than a phone. You can use the SAVE button at the bottom of the form to save your answers and come back to them.
      - Answer as fully and honestly as you can. Incomplete answers reduce the time available in your first appointment.
      - Your form is only read once your programme is booked and your assessment is scheduled. Submitting the form does not secure an appointment.
      - Complete the sections in order, and only if you intend to book.

      WHAT YOU WILL NEED
      - Your vet's practice details. Your vet must complete and sign the veterinary referral form themselves, online. Paper copies and forms handed back to you cannot be accepted. Details: https://kateyaldred.co.uk/veterinary-referral/
      - For rescue dogs from abroad: proof of a negative Brucella test is needed before any in-person appointment.

      APPOINTMENTS
      - In person: Tuesday or Friday mornings
      - Online: Tuesday or Friday midday

      Availability is limited and there is usually a waiting list. Appointments are not available during most UK school holidays, but you can still book for after the break. Closure dates: https://kateyaldred.co.uk/contact/

      NEED HELP?
      - The Behaviour Pathway is a free mini course that guides you through the booking process step by step: https://academy.kateyaldred.co.uk/behaviour-pathway
      - Questions before you begin? Fill in the application form with a few basic details and I will get back to you for a chat: https://kateyaldred.co.uk/application-form-for-one-to-one-help/
      - Problems with the form? Send a WhatsApp message to 07841040171 during business hours.

       

       

    • Please download this multiple-choice form and complete it. You will need this completed form when you get to section Four: Reaction Information.

      WORD VERSION - click here

      PDF VERSION - click here

    • The current appointment schedule for behaviour assessments are as follows. Please tick if you will be selecting In-Person or Online to indicate you understand.*
    • PRIVACY & CONSENT

      The personal data you share with me is used to help with your dog's behaviour issue and to carry out the fact finding I need to do that properly. It allows me to visit you for home visits, communicate educational resources, prepare for group or private sessions, and contact you about the service you have booked, especially in an emergency. It also helps me make sure you receive the correct service.

      A full copy of my privacy policy and GDPR information can be found on my FAQ page: https://www.kateyaldred.co.uk/faq/

      Consent
      By giving consent you are giving me permission to process your personal data for the purposes above. Consent is required for Katey Aldred to process your personal data, and it must be given explicitly. Where I ask you for sensitive personal data, I will always tell you why and how the information will be used.

      You may withdraw your consent at any time by contacting me. Your data will then be erased, apart from any records I am legally required to keep.

    • Privacy & Consent*
    • Section One: Owner Information 
    • Section One: Owner Information

    • TECH CHECK:

      - Complete with a tablet or computer

      - Ensure you have a stable internet connection

      - Ensure you enter the correct email address

      In case of an issue, send a text or WhatsApp to Katey on 07841040171 in the first instance. A reply will be sent during business hours. You can check these and for any planned annual leave on the contact page of the website: www.kateyaldred.co.uk/contact 

      Issues are usually related to the browser and device you are using. Please do not use a phone. 

    •  -
    • Section Two: Dog's Information 
    • Section Two: Dog's Information

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    • Origin of your dog*
    • Rescues from abroad: Has your dog been tested for Brucella? (you will need to provide proof of a negative test result to be seen in person).*
    • Gender and neutered status*
    • Previous Owners?*
    • Daily Interactions - please select the best descriptor for each activity*
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    • Methods & Training History Please put select any that you use/have used:*
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    • Training History (please tick all that apply):*
    • What training exercises can your dog do to what standard?*
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    • Health & Medical

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    • Appetite & Elmination *
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    • Section Three: Aggression Screen 
    • Section Three: Aggression Screen

      Please answer honestly & openly. You must provide full disclosure especially in cases of human aggression. In case of human aggression your dog's welfare along with assessor safety is very important. Failure to provide this information may result in the service being terminated without refund. If your dog has human aggression the assessment will need to be via video call. Please ensure you have discussed this with the assessor.
    • Safe Guarding Statement

      During the application process, you may have been advised that you need an ONLINE ASSESSMENT/PROGRAMME due to human aggression. On completion of this form, you will be provided with access to booking. If you disregard the safety measures in place and book an in-person programme, your sessions may be cancelled and refunded (minus a processing fee as per the T&C's).

      Please write your name to indicate you have read this statement, understand and will comply. (If your dog does not have aggression, this doesn't apply to you, please write N/A) *

    • If your dog has bitten (either people or other animals), please tell us about the bite/s:*
    • Unfortunately, this level of bite is severe and the prognosis is poor. If you haven't already done so please discuss this with Katey Aldred before continuing with your assessment.

    • Please pause here and contact Katey via WhatsApp on 07841040171 before proceeding with this form. 

    • Has your dog displayed any of the following (please tick all that apply):*
    • What do you feel is the potential for injury?*
    • Section Four: Reaction Information 
    • Section Four: Reaction Information & multiple choice

    • Multiple Choice Reaction Information Form

      In this section you will need to upload your form that you were prompted to download in the VIP section.

      In case you missed that part. Please download this multiple-choice form and complete it. Then use the upload button below to provide access. 

      WORD VERSION - click here

      PDF VERSION - click here

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    • Section Five: Toilet Habits (optional - skip if no issues) 
    • Section Five: Toilet Habits

      Skip this section if you have no issues with toileting
    • Please select any/all that apply for toileting in the wrong place
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    • Please select any/all that apply for toileting in the wrong place
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    • Section Six: Separation Information (optional - skip if no issues) 
    • Section Six: Separation Information

      Skip this section if you have no issues with separation behaviour
    • Please read: This section is to gather information on separation related behaviours. If your dog has never displayed any issues with this you can skip this section. 

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    • Section Seven: Behaviour Problem 
    • Section Seven: Behaviour Problem

      This section is for more details on the answers you have already provided above
    •    
    • Do you have a second issue you need to tell us about?*
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    • Do you have a Third issue you need to tell us about?*
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    • Section Eight: Anything Else? 
    • Section Eight: Additional Information

      Have we missed anything?
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    • Section Nine: Insurance Claims 
    • I understand that if I am planning to submit a claim I need to pay in full then claim it back*
    •  

      As standard, one insurance claim form and one invoice are included per programme purchased. If the claim form requires a "veterinary surgeon signature," this must be completed by the referring vet, not Katey. If an insurer specifically requires the behaviourist's signature, written confirmation permitting this must come directly from the insurer before Katey signs anything.

      You are advised to confirm cover with your insurer before starting if you plan to claim (cover varies by policy and provider), and that claims can only be submitted after appointments are completed, not in advance.

      Admin fee for extra insurer workload

      Where an insurer requires additional correspondence, forms, or documentation beyond the standard one form + one invoice, additional administrative time is charged at £40 per hour, billed in 15-minute increments. The client should be informed in advance where possible.

      What is covered under one form + one invoice

      This is either one completed form +/- a copy of the veterinary summary letter plus one invoice detailing a breakdown of the programme and appointments attended

      Please Note: if an appointment is cancelled outside the cancellation policy and is not attended but still chargeable, you will be liable for the costs and unable to claim it back through your insurance.

       

    • I understand and have read the information above regarding insurance claims*
    • Section Ten: Questionnaire Submission 
    • Section Ten: Signature Required

    • Appointments are subject to availability and might change between your inquiry and your completion of this process. You will unlock access to the diary once you have purchased your behaviour programme. Once purchased this will trigger automated emails for you to book your own appointments in the diary.

      In submitting your questionnaire and proceeding with a programme you agree to the full terms and conditions which can be viewed here.

       

    • I confirm I have completed this form to the best of my knowledge and agree to the terms and conditions of service as per booking. Full terms and conditions, and privacy policy are available to view on the website here. 

      Please do contact me if your situation changes. I look forward to meeting you and your dog.

    • PLEASE NOTE: When you click on this field to complete your browser might push the box further up the page. Please scroll up if you click to complete but cannot view it and it will be there.

      DATE:   Pick a Date*   *   *  
         

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