Please copy and paste this form into a personal, private email; add your answers and send it to


Please note that all information is confidential and is protected by the Data Protection Act.

Your name, address and telephone number

Your Skype name, if you are on Skype

Name, age, gender and breed of your dog(s)

Is the dog neutered/spayed?

How long has your dog lived with you?

Your dog's known background

General state of health, and medical history

List people living in the house.

Very brief description of issues - we will go into them in depth later.

List a choice of three days and times (evenings preferred) that are convenient for an uninterrupted 2-hour DIAL session.

A photo of your dog(s) whilst not essential would be helpful.  

Disclaimer: In returning this questionnaire to DIAL, I agree that Theo Stewart and DIAL can accept no responsibility nor liability should any damage or injury be inflicted by my dog(s).  I also understand that this is not a 'quick fix' and that good results depend upon the work we ourselves are prepared to put in and in being consistent.

I also understand that there may be things that, due to this being done from a distance, Theo may not be able to pick up regarding my dog, our interaction with him/her and his environment.

 When the questionnaire is completed and emailed to me, please click here to pay.