Behaviour History Questionnaire - Pet Doctors Thorndon

This comprehensive history form explores your pet’s daily ecosystem, medical background, and target behaviour triggers in detail. It is an essential part of preparing for your consultation with Dr Tracy Jones, so please complete it at least 7 days before your appointment.

It takes around 15-20 minutes. You can use “Save and Continue Later” at any point, and there is space at the end to note the video clips you have uploaded.

Step 1 of 8 - Your Details

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This field is for validation purposes and should be left unchanged.

Your Name (Owner)(Required)

Your Email Address(Required)

We use this to match your questionnaire to your referral and appointment.

Patient Signalment & Demographics

Patient Name(Required)

Species

Canine

Feline

Other

Breed(Required)

Date of Birth / Age

Sex & Neuter Status(Required)

Intact Male

Neutered Male

Intact Female

Spayed Female

Age at Desexing (If applicable)

Leave blank if your pet is intact.

Current Weight (kg)

Primary Complaint & Goals

What is the primary behavioural problem you are facing with your pet?(Required)

Please describe the issue using specific actions and body language, rather than labels like "jealous" or "angry".

When did you first notice this behaviour developing?(Required)

How frequently does this behaviour occur?(Required)

e.g., three times a day, twice a week, only when guests arrive.

What are your top two goals or expectations for this behavioural consultation?(Required)

Acquisition & Early Development

Source of Pet

Breeder

Rescue / Shelter

Friend / Relative

Stray

Other

Age at Acquisition

e.g., 8 weeks, 6 months, 2 years.

If known, what was the weaning age from the mother?

Describe any known history regarding the pet's parents, littermates, or early life before you acquired them.

e.g., raised in a commercial kennel, feral colony, home environment.

Household Structure & Daily Ecosystem

Human Household Members(Required)

Please list all people currently living in the home, including ages of children.

Animal Household Members

Please list all other pets currently living in the home (Species, Breed, Age, Sex).

Home Environment Type

Apartment / Flat

Suburban House

Rural Property / Farm

Other

Fencing & Outdoor Access

Fully fenced yard

Unfenced yard

Balcony only

Indoors only

Where does the pet sleep at night?

How many hours per day is the pet left completely alone?(Required)

Where is the pet kept when left alone?

e.g., loose in house, crated, outdoors, laundry room.

Describe the pet's typical daily exercise routine.

Duration, frequency, on-lead vs off-lead.

Target Incident Log

THE FIRST INCIDENT: Please describe the very first time this behaviour occurred.(Required)

Include: Approximate date, location, who was present, triggers/context, exactly what your pet did, and your immediate reaction.

THE WORST INCIDENT: Please describe the most severe escalation of this behaviour.(Required)

Include: Date, location, context, and exact details. If a bite occurred, please note if skin was broken and where on the victim.

THE MOST RECENT INCIDENT: Please describe the last time this behaviour occurred.(Required)

Include: Date, location, context, what your pet did, and how you responded.

Historical Interventions & Training

What training methods have been used with this pet?

Reward-based / Positive Reinforcement (Treats, toys, clicker)

Balanced training (Mix of rewards and corrections)

Verbal corrections ("No!", shouting)

Physical corrections (Smacking, scruffing, alpha rolls)

Training Tools Used

Flat collar

Front-attach harness

Head halter

Check chain

Prong collar

Citronella or Shock collar

None

How does your pet respond when corrected or scolded?

Cowers / Hides

Freezes / Stiffens

Growls / Snaps / Shows teeth

Ignores / Continues behaviour

List any professional trainers or behaviourists you have previously consulted, and the results achieved:

Medical, Dietary, & Structural Review

Is your pet currently taking any regular medications or supplements?

Include flea/tick preventatives, pain relief, and behaviour supplements. Note drug name, dosage, and frequency.

What is your pet's current exact diet?

Brand name, commercial wet/dry, raw diet, home-cooked food.

Has your pet suffered from any major illnesses or injuries in the past?

Does your pet have a known history of any of the following?

Chronic skin itching or ear infections

Gastrointestinal upsets (Vomiting, soft stool, frequent flatulence)

Intermittent limping, stiff rising, or reluctance to jump

Increased thirst or changes in urination frequency

None of the above

Behavioural Video Clips

SAFETY FIRST: Never intentionally trigger, provoke, or escalate an aggressive, fearful, or dangerous response just to capture it on camera. Clips of normal resting posture, minor early warning signs, or the layout of your home are incredibly helpful.

If it is safe to do so, please upload 2 to 3 short video clips (under 60 seconds each) of your pet's behaviour or household setup to the secure Google Drive folder linked in your welcome email. If you cannot find the link, contact us at thorndon@nzpetdoctors.co.nz.

Video links or notes (optional)

If you have uploaded videos already, or have links to share (e.g., Google Drive, YouTube), paste them here.