This questionnaire should only be completed if you have a behaviour consultation booked with Widget's Farm

Name *
Name
Address *
Address
Phone *
Phone
ABOUT THE PATIENT
Dog's Gender & Neutering Status *
Please pick one option
Date when neutered (if applicable)
Date when neutered (if applicable)
This can be a rough date.
Please provide best guess if unknown
Date First Acquired *
Date First Acquired
Name of Breeder, Rescue, Private Seller etc
If you got your dog straight from the breeder, can you describe the breeders set-up? For example, did you see the parents? Was the puppy's pen in the breeder's home?
If your dog was a rescue, what do you know of their life and situation before you had them?
Have you owned a dog before? *
Have you owned this breed before?
THE HOUSEHOLD
MEDICAL HISTORY
Last Vaccination Date (Approx) *
Last Vaccination Date (Approx)
If yes, please describe
If yes, please provide details.
If yes, please describe.
Please tick any of the behaviours your dog undertakes at least once a week *
If yes, which area
TRAINING & OBEDIENCE
Please complete this section is you had your dog from a puppy or know some of their early history.
Has your puppy ever attended a training class?
For example, how were you taught to train a loose lead?
Were the puppies offlead or onlead in class?
How well did your dog do in class?
Did you ever attend puppy parties at your vets?
What cues does your dog do on command?
Does your dog ever pull on the lead? *
Is your dog more obedient with some people more than others?
DIET & FEEDING
Is the dog protective around food? *
(ie, stiffening, growling, snapping)
Is her appetite good or poor? *
Does your dog eat quickly or slowly? *
Is your dog given any slow feeding items such as bones, chews or stuffed kongs? *
If yes, is your dog protective over the item? (ie hiding with it, tense body language, growl etc).