Consulting Application Form
Behavior & Personality Evaluation For Dogs
Please complete this questionnaire as thoroughly as possible. All of your answers will be confidential.
The details you provide will give an initial understanding of your dog's problems. We want our first consultation to be as helpful as possible so please collaborate with others in your home.
More information as well as more perspectives will make a bigger difference. If you do not know the answer to any of the questions, please write in UNKNOWN.
Finally, your dog's regular veterinarian needs to stay informed. This will be especially important if medications are recommended or if there is a physical component to the behavior concern. You may need to report to your veterinarian as we progress. We will consult with you on the behavior issues until we get the best possible result. If there are more serious neurological issues suspected, a referral to a Board Certified Veterinary Behaviorist may be suggested.
Pet Owners Name
Best Contact Phone
Alternative Contact Phone
Physical Address (please include city)
Name and address of regular veterinarian
What is your living arrangement?
House with Small Yard
House with Large yard
Please list the people (including yourself) who are living in the household. Name - Sex - Age - Relationship to you - Occupation - # of Hours at home each day
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