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Sample Case Analysis
Report
PetEthogram |
Pet Owner Profile
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First and Last Name: (eg. "Mary Smith")
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Jane Jones |
First Choice Phone:
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573-789-5555 Ext: |
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Home Address:
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Any Street |
Second Choice Phone:
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606-545-5555 Ext: |
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City, State, Zip:
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AnyTown, CA 65478, |
FAX or Third Choice Phone:
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Ext: |
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Name of current Trainer (if any):
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None |
Email Address:
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SampleEmail@Yahoo.Com |
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How did you hear about ABN?
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Veterinarian |
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Pet Profile
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Pet Name:
(What you actually call the pet.)
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Amber |
Species and Gender:
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Female / Spayed |
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The body appears most/all as the
Breed:
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Cocker
Spaniel
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Color:
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Buff |
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Current estimated weight (lbs.):
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22lbs. |
Date born:
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4-20-2001 |
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How many years have you owned your pet?
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2.5yr
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Obtained
at what pet age?
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18 months |
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Obtained from:
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Breeder
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Pet Lifestyle
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Select all Lifestyle aspects that apply:
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On Some Furniture, Sleep On Owner Bed
, Single Family House, Suburban Setting |
Hours per week walking &
interactive play?
(Or fraction e.g. 0.5 hr/wk)
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6
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% of time
loose inside house when owner is home?
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90
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Favorite rewards
(e.g. praise, petting, treats, etc.)
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Car rides, Laptime, Petting, Praise,
Treats, Walks |
Favorite games
(e.g. ball, frisbee, tug-of-war, etc.)
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Laptime, Petting, Tug-o-war
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| Any dry food left down? |
Sometimes
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Describe the pet's current diet, including brands:
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Iams
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Rate the strength of your bond with this pet:
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(1=low, 10=high)
9 |
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Plan to professionally Groom:
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x per year average
8 |
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Professionally Board:
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days per year average.
2
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Total # of household Dogs:
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2 |
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Total # of household Cats:
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0 |
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Veterinary Hospital Affiliation
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I have a "regular vet" for this pet:
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Yes |
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Primary Veterinary Hospital Name:
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Sample Vet Hospital |
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Hospital Address:
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CityStreet
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City, State, Zip:
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AnyTown, CA 65498,
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Veterinarian's Last Name:
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Dr.
Smith |
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Hospital Phone:
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555-555-5555 |
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Hospital Fax:
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555-456-4567 |
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Hospital Email:
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SampleVetHospital@Vets.Com |
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Veterinary Medical
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List any significant
past medical conditions |
Vaccine Reaction, chronic ear
infections, allergies |
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List any significant
current medical conditions |
Allergies |
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Current medications
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Heartworm
prevention
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Canine Training
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# of DAYS attended off-leash Puppy Classes before 6 months of age:
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5 |
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# of DAYS attended adult Obedience Classes after 6 months of age:
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0 |
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Any Obedience Certification? CGC, TDI, CD :
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None |
(DOGS) Basic Commands: RATE 0-10, current reliability of commands (0=not taught; 10 = best)
Assume the dog is off-leash at a park (off-property), with NO strange dog or person nearby.
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Come:
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2 |
Sit:
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7 |
Down:
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3 |
Stay:
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0 |
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Heel:
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0 |
House trained:
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20 |
Crate trained:
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5 |
Head halter:
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Never Tried |
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Primary Concern
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INSTRUCTIONS
In this section, try to think of the concern in THE BIG PICTURE. Use the down arrows to select
the OVERALL CLOSEST match, and try to put something in every field.
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PRIMARY BEHAVIOR CONCERN:
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Separation Anxiety |
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Status of behavioral concern:
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Worsening |
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Duration: (First began)
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Since owned
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Tally. What is the total number or times it has happened?
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Countless |
| Predictability:
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Intermittent
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Frequency between occurrences:
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Days |
Severity in the last month on scale of 1-10:
(1= Mild, 10 = Severe)
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10
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Tried what techniques so far?
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Scruff, Time-Out, Yell No!, Spank Rump
, Bitter Apple |
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Response to attempts at solution?
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No effect on Problem
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Is surrender of this pet being considered for this concern?:
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Maybe
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Include here any other information regarding only your PRIMARY concern. Other concerns are addressed below.
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She needs to be able to be left alone!
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Concern Inventory
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Aggression Toward
People:
None
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Aggression Toward Animals:
None
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Barking:
Animals outdoors, people
outdoors, other dogs
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Begging:
at table, to get in, to go
out
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Chasing:
None
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Chewing:
Chews things when we're
gone
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Clawing/Scratching:
Scratches at doors
and kennel when we're gone
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Digging:
Digs up flower beds
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Eating disorder:
None
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Geriatric (Senile) changes in:
None
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Fearful of:
Groomer, veterinarian, loud
noises
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Housesoiling Feline:
N/A
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Housesoiling Canine:
at greetings, when excited
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Licking:
None
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Jumping:
when excited, on furniture, on guests, on kids
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Pulling on leash when using:
Choke collar
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Obsessive
Repetitive:
None
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Unruly:
None
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Sleep
changes:
None
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Won't come when called:
lost training, when
distracted |
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Problem(s) present but not listed above:
Nothing I an think of
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Client Narrative & Notes
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Other Comments
6-8 am out with other dog, drinks water and is then
in house until we get home from work at 6 pm.
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Suggestions
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Behavioral Notes and Assessment
This
sections below are completed by an Animal
Behavior Network Veterinary Behavior Consultant
(VBC), sent to the Attending Veterinarian (ADVM) and
Pet Parent
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Behavior Triggers and Markers for this case
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Training Suggestions
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Product Suggestions
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Medical Services Suggestions
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Behavior Modification Suggestions
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Behavioral Notes and Assessment
...::::::: Copyright 2000-2005 Rolan
Tripp, DVM :::::::...
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