Canine Pre-Consultation Questionnaire

Below is some information I’d like you to collect, if possible, before our phone consultation so we can make the most of our time together. These questions can be easily copied into an email or DOC file and emailed to me with your responses. If you would prefer to have the form sent to you by regular mail or emailed to you directly, please email mm@mmilani.com to request this.

If you have more than one dog, please supply the information for each animal.

Try to get input from others who live with the dog as well as those who see the dog periodically. Not only may dogs relate differently to different people, but we’re also often so close to our dogs that we miss things that others can see.

The fee for phone consultations is $125/hour. Those for aggression, separation anxiety and other complex problems average 2-2 1/2 hours. In most cases that plus the consultation recap, relevant handouts and links, and 8 weeks email follow-up included in the fee usually suffices to get a workable program up and running.

Within 36-hours of the consultation, I’ll email you the handouts and an email invoice with a link to PayPal’s secure online payment center. There you can use your MasterCard, Visa, Discover, or American Express credit card. You do not need a PayPal account to use this service. If you do not have Internet access, please let me know and we can make other arrangements.

If you have any questions about any of this, please email me at mm@mmilani.com.

I look forward to helping you and your dog(s).

Your Name:
Address:
Phone:
Email:
Referred by (if applicable):

Your dog’s name:
Breed:
Sex:
Age:
Weight:

1. Where, when, and how you got your pet. (If you know any information about your dog’s littermates, including number of males and females in the litter, and/or about your dog’s parents, that would also be helpful.)

2. If and when your dog was spayed or neutered.

3. Where does your dog eliminate, i.e. pee and poop? Does your dog lift his or her leg when urinating? If so, where and when does this occur?

4. Basic information (age, sex, species, breed) of other animals in the household or with whom your pet routinely interacts.

5. Basic information (age, sex) of other people in the household or with whom your pet routinely interacts.

6. An overview of your pet’s pertinent medical history.

7. What your dog eats and how, i.e. gulps, disinterested, snacks, leery of / aggressive toward others when eating.

8. What specific behaviors does your dog display:
-- In the car

-- When you’re gone, i.e. is there evidence that your pet is distressed, such as chewed objects, house-soiling, vomiting or drooling?

-- When you and other family members come home, e.g. jumping, barking/whining, bring toys, etc.
(Note any differences that occur with different family members)

-- When visitors arrive. (Note any differences toward men, women, adults and kids, little boys vs. little girls.)

-- Toward other dogs. (Note any differences toward males and females, unneutered and neutered.)

9. Does your dog play? If so, how?

10. Does your dog display any sexual behaviors such as mounting, masturbating, or getting between you and others when you are displaying affection toward each other?

11. Finally, list the problem displays in chronological order from the first to the most recent incident. Jot down notes about the circumstances surrounding each event and how you and/or others responded to it. Include any events that may have troubled you, even if they didn’t create any serious problems for you at the time or don’t seem related to the current problem. If medical treatments were involved, please note these also.