Consultation Form

Please fill in the form below to the best of your knowledge.
If you are not the main carer of the dog mentioned please make sure the information provided is correct.

Your Full Name(required)

Your Full Address(required)

Your Phone Number(required)

Your Email(required)

Your Professional Occupation(required)

Your Age(required)

Dog's Name(required)

Dog's Breed Type(required)

Dog's Age(required)

Dog's Sex(required) Male

Female

Neutered/Spayed(required) Yes

Please provide date of surgery.

Please explain where and how the dog was acquired.

Please provide as much information as possible (facts only) regarding the dog's background.

Please describe for how long is the dog under your care.(required)

Please describe when was the dog's last vet visit and the reason for it.(required)

Health Status(required) Completely healthy

Some health issues

Please describe any health issues and/or any medication, supplements or vitamins used in the past year.

Please confirm if the dog has any food allergies(required) None

Yes

If yes, please provide more information below.

Rabies vaccine(required) Up-to-date

Not up-to-date

Please provide the dog's vet name and contact if possible.(required)

Please check the boxes which represent the behaviour problems you have been experiencing with the dog(required) The dog has shown the behaviour problems to Adult Humans Inside the Home

The dog has shown the behaviour problems to Adult Humans Outside the Home

The dog has shown the behaviour problems to Children Inside the Home

The dog has shown the behaviour problems to Children outside the Home

The dog has shown the behaviour problems to other Dogs Inside the Home

The dog has shown the behaviour problems to other Dogs ouside the Home

Please describe situations where you have seen the behaviour problems mentioned above.(required)

Please describe the first time you have seen the behaviour problems mentioned above.

Please describe the last time you have seen the behavour problems mentioned above.

Please confirm if there is any video footage of the behaviour problems mentioned above(required) Video footage available

Video footage not available

Please confirm if the dog has ever inflicted an injury to another Dog .(required) Yes, he did.

No, never.

Please confirm if the dog has ever inflicted an injury to another Human .(required) Yes, he did.

No, never.

If applicable, please describe the first time the dog inflicted an injury to another Dog.

If applicable, please describe the last time the dog inflicted an injury to another Dog.

If applicable, please describe the first time the dog inflicted an injury to another Human.

If applicable, please describe the last time the dog inflicted an injury to another Human.

Please describe the last positive social interaction between the dog and any other dog from outside the home in the last 6 months.(required)

Please describe the last positive social interaction between the dog and any other human from outside the home in the last 6 months.(required)

Please describe the Dog's Daily Routine including sleep patterns, exercise, play and social time with family members.

Please describe if the dog is left alone at any point, and if so, where and for how long.

Please describe if the dog is disturbed by anything when inside the home (Noises; Deliveries; Neighbours; People and/or Dogs walking by the home).

Please describe how's the Dog fed, how many times per day and by whom.(required)

Please describe the dog's favorite food treats and if he is interested to eat these on walks.(required)

Please describe the dog's favorite toys and if he is interested to play with these on walks.(required)

Please describe the dog's favorite activities and if he is always willing to engage in these.(required)

Please confirm if there are any Children under 15 years old in the home.(required) Yes

Please confirm if there are any other animals in the home.(required) Yes, Dogs

Yes, Cats

Yes, others

Please confirm if you have used any other dog professionals in the past.(required) Yes

If applicable, please describe for what reason you have seen other dog professionals and when was the last appointment.

Please describe if you have tried to solve the behaviour problems mentioned above. And if so, please provide as much information as possible regarding tools, methods, and approches used.

Please describe how many people care for the dog and what tends to be the task of each person involved.

Please describe if the dog can be transported in the car and if there are any issues involved with this experience.

Please describe if there are any restraints which may affect the behaviour modification process (financial; time; transport; health).

Please describe in realistic terms what you are looking to achieve with the behaviour modification process.(required)

Please add below any other details in relation to the dog if needed.

I accept the Terms&Conditions – https://reactivedogs.solutions/tc/(required)

I understand that Defensive Handling Techniques may be used with the Dog to protect everyone involved if the dog shows aggressive behaviour.(required)

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