Client Behavioural History Questionnaire Owner’s Name Owner’s Address Telephone Number Email Name of Veterinary Surgery Branch Insurance Company (if applicable) Name of Pet Breed Age Age Obtained From Where Gender Neutered ---YesNo Age Neutered List the Human Members of the Household List the Other Animals in Household Diet When Fed Exercise Duration Exercise Frequency Exercise Location On/Off Lead? ---On leadOff lead Previous Training Undertaken How Often is Your Pet Left Alone? Briefly Describe Your Pet’s Personality When Did the Problem Begin? Briefly Describe Your Pet’s Behaviour Problem Relevant Medical History How Much Time Would You be Able to Commit to Resolving the Problem? Are You Able to Enlist Neighbours and Friends to Help? Are the Members of the Household Willing to Help? What is Your Desired Outcome of Behavioural Modification?