OWNERS DETAILS

YOUR NAME*

TELEPHONE *

ADDRESS*

Email Address*

HOW DID YOU HEAR ABOUT US*

PET DETAILS

NAME*

PET TYPE

dog cat

BREED/TYPE*

SEX*

MALE FEMALE

PRESENT AGE*

NEUTERED* YES NO UNSURE

AGE NEUTERED

AGE ACQUIRED*

FROM WHERE *

BREEDER - HOME BREEDER - KENNEL A FAMILY HOME RESCUE FARM OTHER

VETERINARY PRACTICE (name, address, telephone)*

CURRENT MEDICAL PROBLEMS *

SUMMARY OF PROBLEM

SUMMARY OF PROBLEM*

HOME ENVIROMENT

ADULTS NAME, CHILDRENS NAME, AGE - time spent daily with pet *

WORK COMMITMENTS - PROFESSION (FULL OR PART TIME?) *

OTHER FAMILY PETS - type, age *

DIET

COMPLETE DRY FOOD ONLY
TINNED AND OR SACHET MOIST FOOD ONLY
COMBINATION OF BOTH
ADDED CHICKEN, MINCE, FISH, ETC
SAME AS WE EAT
EGGS, MILK, CHEESE
BREAKFAST CEREAL AND OR TOAST
OTHER please state below

OTHER (from above)

FEEDING ROUTINE

ONCE A DAY
TWICE A DAY
THREE TIMES A DAY
FOUR TIMES A DAY
MORE THAN 4 TIMES
WHEN BOWL EMPTY

TREATS including chews, bones (how often)

EATING HABITS *

FUSSY EATS ANYTHING DEPENDS

TRAINING *

DAILY OCCASSIONALLY NOT REALLY

GAMES, PLAYING WITH FAMILY OR ON OWN*

NEVER LESS THAN 30 MINUTES DAILY 30 - 60 MINUTES DAILY MORE OFTEN MOST OF THE TIME

TYPES OF TOYS (FAVOURITE)

DAILY ROUTINE (including feeding, playing, walking, sleeping)*

SLEEP HABITS *

NORMAL (on and off during day and over night) LOTS (most of time) NEVER REALLY SETTLES (but ok overnight) NEVER REALLY SETTLES (even overnight)

PETS RESTING PLACES

please state for each of the next 3 options

WHEN YOU ARE AT HOME RELAXING

OVER NIGHT

WHEN LEFT HOME ALONE

PETTING/ATTENTION SEEKING *

NORMAL DOESNT LIKE MUCH EXCESSIVE

EXERCISE -WALKING, ETC*

NEVER WEEKLY NOT OFTEN DAILY (SEE BELOW)

DAILY WALKS - TOTAL DURATION

LESS THAN 20 MINUTES LESS THAN 30 MINUTES LESS THAN 40 MINUTES LESS THAN 60 MINUTES BETWEEN 1 - 2 HOURS MORE THAN 2 HOURS

OFF LEAD *

NEVER ALWAYS SOMETIMES (see below)

PERCENTAGE OFF LEAD

FREQUENCY OF INTERACTIONS WITH DOGS

DAILY
WEEKLY
TRY TO AVOID
OCCASSIONALLY
NEVER

DOGGY FRIENDS

NONE
ONE OFTEN
ONE OCCASSIONALLY
TWO OR MORE OFTEN
TWO OR MORE OCCASSIONALLY

PROBLEMS WITH PEOPLE

only fill in details if your dog has issues with people

PROBLEMS WITH PEOPLE

ONLY ON THE LEAD
ONLY OFF THE LEAD
BOTH ON AND OFF LEAD
AT HOME ONLY
BOTH HOME/OUTSIDE

BEHAVIOUR SHOW (select more than 1 if required)

IGNORES BARKING LUNGING CHASING GROWLING HACKLES UP SNAPPING ATTENTION SEEK SCRATCH BITE HISS SPIT

PROBLEMS WITH OTHER ANIMALS

only fill in if your pet has problems with other animals

PROBLEMS WITH ANIMALS

AT HOME ONLY
BOTH HOME/OUTSIDE
ON LEAD ONLY
OFF LEAD ONLY
BOTH ON/OFF LEAD

BEHAVIOUR SHOWN

IGNORES
BARKING
LUNGING
CHASING
GROWLING
HACKLES UP
SNAPPING
ATTENTION SEEK
SCRATH BITE
HISS SPIT

ADDITIONAL COMMENTS