Mater Pet Therapy - Self Assessment
Owner Details
Name
Email
Phone
Hospital Location
Which Hospital location are you applying for?
Dog Details
Name
Breed
DOB
Sex
Desexed?
Yes
No
Assessment Questions
How does your dog react to other dogs?
How does your dog react to walking up and down stairs?
How does your dog react to different floor surfaces?
How does your dog react to lous noises? e.g. sirens, alarms, back-firing cars, etc.
How does your dog react to people running past?
How does your dog react to people in wheelchairs or mobility scooters?
Does your dog nip, mouth or chew people?
Yes
No
Does your dog growl when people approach?
Yes
No
Does your dog growl/snap/bite when you go near its food?
Yes
No
Does your dog howl or cry for attention?
Yes
No
Does your dog shy away from people?
Yes
No
Does your dog urinate when people approach?
Yes
No
Does your dog frequently lick people?
Yes
No
Does your dog frequently jump up on people without being asked?
Yes
No
Is your dog able to be handled by strangers?
Yes
No
Obedience Skills
Can your dog perform the below taks on command with a hand signal/vocal cue?
Sit
Drop
Stand
Stay
Come when called
Walk on a loose lead
'Leave-it' cue
Toilet on cue
Sit
Drop
Stand
Stay
Come when called
Walk on a loose lead
'Leave-it' cue
Toilet on cue
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