Behavioural Consultation Form
Please complete and submit at least 72 hours before your consultation. If you have any problems please contact Kintala on 0141 952 2990. Thank you.
Dog(s) Guardian Name
*
Full Address
*
Post Code
*
Mobile Number
*
Home (2nd Contact Number)
Email Address
Back
Dog Details
Dog's Name
*
Breed
*
Age
*
Sex
*
Male
Female
Spayed / Neutered
*
Yes
No
Back
Problem Behaviour Details
What Behaviours Are You Having Problems With (tick all that apply)
*
Jumping Up
Pulling on Lead
Barking
Reactivity-Dogs
Reactivity-People
Chasing/Impulse
High Energy
Over Excitement
Biting/Nipping
Stress/Anxiety
Recall
Other:Note below
If Other then please detail these here
Does your dog display any form at all of aggression/reactivity (snarling, lunging, biting etc?)
*
Yes
No
Number of instigated fights. If none type '0'.
*
Number of times your dog has bitten another dog. If none type '0'.
*
Number of times your dog has bitten a person. If none type '0'.
*
Number of times your dog has been attacked/bitten by another dog. If none type '0'.
*
Has any VET or HOSPITAL treatment ever been required in any instance(s)?
*
Yes
No
If yes, then please detail the events below.
*
Is your dog currently on, or recently been on, any medication, vet treatment or special diet?
*
Yes
No
Please note the details below
Please add any other information you may think helpful
Have you engaged a behaviourists/trainer previously for your dog?
*
Yes
No
If so, Please note their details below (including contact name/number if you have a note of these) as well as the outcome/prognosis of the session(s) and recommendations etc
*
How long ago was this?
*
Are you happy to let Kintala to contact them?
*
Yes
No
Back
Background Information
Have you had your dog since 8 weeks of age?
*
Yes
No
How long have you had your dog?
*
Is your dog a rescue?
*
Yes
No
Has your dog come from a, or suspected, puppy farm?
*
Yes
No
Can you tell me a bit about your dog's known background?
*
Has your dog completed any formal (obedience) training?
*
Yes
No
How long ago was this?
*
0-3 months ago
3-6 months ago
6-12 months
Over 1 year ago
Over 2 years ago
3+ years ago
How did they perform at training (generally)
*
Very Good
Good
Okay
Not Great
Very Poor
Did your dog have early socialisation with other dogs/people (up to age 6 months)?
*
Yes
No
Don't Know
Do you have set meal times for your dog?
*
Yes-once a day
Yes-twice a day
Yes-3 times/day
No
What food (including treats) is your dog given?
*
Back
Vet Details
Vet Name
*
Vet Address
*
Vet Contact Number
*
Does your dog have any medical or allergy issues? (if so, detail below). If None type NONE in the box below.
*
Detail here any prescribed medications your dog takes. If none type 'NONE'.
*
Are all of your dogs vaccinations up to date?
*
Yes
No
Has your dog had the kennel cough vaccine (including annual boosters)?
*
Yes
No
Date of last VET check up
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Finally, How did you hear of Den Cooke (Pawsitive Harmony)?
*
Submit
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