Owners Name(s) * Address * Address where you wish the assessment to take place Postcode * Contact telephone number * Email address * Number of adults in your house * Number of children in your house * Age(s) of children (if applicable) Dogs name * Dogs breed(s) * Dogs age (months, years) * Male or female? * Male Female Age when obtained (months, years) * Where did you get your dog? e.g. breeder, rescue, friend etc. Is your dog neutered or spayed? * Yes No Is your dog fully vaccinated? * Yes No Has your dog had any health problems? * If yes, please give details Vets name * Date of last visit * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20162017201820192020 Do you have any other pets? * If yes, please give details and ages What do you feed your dog? * Please give type / brand How many times a day do you feed your dog? * Do you feed any additional food or treats? If yes please give details Any toileting problems? How much exercise does your dog get? Number of walks, how long is each How many days a week do you take your dog out? What toys or objects does your dog like to play with? Where does your dog sleep? Please describe the issues you are having with your dog. Give as much details as possible. If you can please take a video of the problem behaviour(s) for us to review at the visit CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.