Name*
Email*
Primary Number*
Address*
City, State, Zip*
Breed*
Weight*
Age*
Gender MaleFemale
Spayed/NeuteredUnaltered If yes, at what age was spayed or neutered?
Who is authorized to pick up the dog?
Any medical history that might be pertinent?
Dog Allergies?YesNo If yes, please list allergies
Phone*
Vet Name*
Phone Number*
Does your dog take any medications?YesNo If yes, please list all medications.
Please email or bring with you your dog(s) Vaccination Records.
Your dog needs to be up-to-date on the following vaccinations:
Rabies
DH2PP
Fecal Float (to test for parasites)
Please answer accurately and honestly so we may best serve your needs.
Person(s) handling dog at home*
Are there minors in the householdYesNo If yes, ages?
Who will be responsible for the dog's training?*
Have you owned a dog before?YesNo If yes, what type? How were they trained?
Why did you get your dog? (check all that apply)* CompanionPrimarily for the kidsHome ProtectionCompanion to other dogTo do activities with (running, dog sports, etc)
Why did you select this particular dog over others? What traits were most important to you?*
Are there other animals in the home?YesNo If yes, please specify species, gender (neutered/spayed?, and age).
Have you moved since you acquired your dog?YesNo If yes, number of times.
Check off the amount of time your schedule allows for working with your dog and training. Busy, very little timeModerately busy, some timePlenty of time available
What type of housing currently.*HouseHi-riseApt/condoTownhouseOther
Do you have a yard?YesNo If yes, what type of yard (fenced?)
What are your dog's toileting areas?* The yardOn walksPuppy pads or litterbox
Is housebreaking a concern to you currently?YesNo If yes, please explain.
Is your dog allowed free range of the home?YesNo
Does your dog chew, steal, or destroy things inappropriately?YesNo
Is your dog accustomed to being crated or confined? YesNo If yes, please check all that apply. Plastic airline-type crateMetal mesh type crateExercise penDog run
How does your dog behave when crated?
How often is your dog crated?
What, if anything, is inside your dog's crate?
Is your dog allowed on furniture?YesNo
Has your dog ever eaten, or swallowed, bedding or other non-food objects?YesNo If yes, please describe.
How does your dog behave while you are not home? Is barking or separation anxiety an issue?*
How is your dog exercised? (check all that apply)* BackyardWalksJogging/RunningPark or ForestDog ParkDaycareGames of FetchPlaying Tug-of-WarTreadmillPlaying with other dogs Other
How often per week (on average) of which types of exercise?*
Do you use a dog walking service?YesNo
Has your dog ever been boarded or attended a daycare?YesNo If yes, where and how long?
Any issues in boarding, daycare, or behavioral changes upon returning home?YesNo If yes, please describe.
What is your dog's overall activity level*Very lowLowAverageHighVery HighHyperactive
Check all that you feel describes your dog's personality*NervousHigh StrungStubbornSuspiciousAbove average intelligenceSlower to LearnVery affectionateDominantSubmissiveSensitiveIndependentProtectivePredictableUnpredictableTraumatizedSpoiledPrey drivenPrefers dogs over peoplePrefers people over dogs
Does your dog exhibit fears or phobias? (thunderstorms, noises, fear of objects, etc.)YesNo If yes, please specify.
What makes your dog feel uncomfortable? Please explain in detail.*
How does your dog behave in and around the car?*
Does your dog ride loose, or in a crate, or a car harness?*
Is your dog possessive of food, toys, or bones?YesNo If yes, please describe.
If your dog steals an object (socks, human food, garbage, etc.) how easily are you able to get the object back? Does your dog ever become upset (growling, fearful, guarding) over an object?*
How would you describe your dog's general social skills with other dogs?*ExcellentNeeds workPoorUnknown
Does your dog ever play off-leash with other dogs?YesNo If yes, please describe.
Describe your dog's behavior if passing other dogs on walks.*
Collars you have used or tried previously (check all that apply).* Electronic collar (specify type below)Buckle collar, nylon or leatherBody harness (specify brand below)Prong/pinch collarHead harnessChain training collarOther (please specify)
Which equipment do you currently use, and why?*
What are your TOP THREE training goals? How much of a problem do you consider these behaviors to be?* Goal #1* Goal #2* Goal #3*
Goal #1 When did this become a concern?* What has been done so far to correct the problem?*
Goal #2 When did this become an concern?* What has been done so far to correct the problem?*
Goal #3 When did this become an concern? What has been done so far to correct the problem?
What is your dog's training history? Please check all that apply.*None or very little trainingBasic obedience classTrained yourselfIntermediate or Advanced obedience classSent to trainer or Bootcamp trainedClicker trainedPuppy classPrivate lessonsProtection or guard trainingIn-home lessonsOther If Private Lessons, how many? If Other, please describe. (eg: agility, protection, hunting, etc.)
Who was the primary person in the family doing the training?*
If you attended classes or worked with a trainer, when? What trainer or company did you work with?
How do you discipline/correct your dog for misbehavior? Please be specific.*
Which cues/commands does your dog know, and how reliably do they perform it immediately when asked to*? (Use %, i.e. "Sit 50%"
Sit
Heel
Sit and Down (verbal only)
Down
Come
Walking on a loose leash on one side
Long stay
Place (go and stay on bed)
Leave it
Other (please specify)
Do you ever let your dog off the leash in areas other than your own yard?YesNo If yes, where?
If yes, how does he/she behave when off-leash?
What is your dog's reaction to outdoor animals (squirrels, rabbits)?*
Has your dog ever run away?YesNo If yes, please describe.
What is your dog's response to being approached by a friendly stranger on a walk?*
What is your dog's response to visitors to the home? Please explain in detail.*
Where is your dog when you receive unfamiliar visitors? (handymen, delivery driver, etc).*
Your dog's food is Available 24 hours/free fedSpecific times Time: Time: Time: Other (please describe):
Who feeds your dog?*
Where does your dog eat?*
Will your dog wait (like a sit/stay) to eat his food until released?YesNo
Does your dog get treats, bones, or chews?YesNo If yes, type/brand
Is your dog*UnderweightIdeal weightOverweight
Is your dog sensitive about any body part being handled or groomed? ( i.e. tail touched, paws touched, nail trims, brushing, etc.)YesNo If yes, please describe area of bodyand typical reaction.
Does your dog exhibit any odd or strange behaviors? (repetitive behavior, obsessive, confusion, etc.)YesNo If yes, please describe.
Have you ever discussed training or behavior concerns with your vet?YesNo If yes, what was discussed?
Does your dog have any previous or current medical conditions?YesNo If yes, please specify.
Is your dog currently taking medications or supplements?YesNo If yes, specify type and purpose.
Has your dog bitten another dog?YesNo How many incidents? Was skin punctured?YesNo Were there stitches?YesNo Were there vet visits?YesNo If additional incidents, please address each.
.
Has your dog bitten a human?YesNo How many incidents? Was skin punctured?YesNo Were there stitches?YesNo Were there vet visits?YesNo If additional incidents, please address each.
Is there any additional information that has not been addressed in this form?
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