Name
*
Owner Information
First Name
Last Name
Phone
*
(###)
###
####
Email
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
DOG INFORMATION
*
If more than one dog, please list all their first names with a comma (,)
First Name
Last Name
Breed(s)
*
Where did you acquire your dog(s) from?
*
Is your dog currently on flea and/or tick prevention?
*
Is your dog on any medication?
*
If yes, please list your dog(s) medications?
VETERINARIAN INFORMATION
*
Veterinarian Name
First Name
Last Name
Veterinarian Office Name & Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Veterinarian Office Phone
*
(###)
###
####
Veterinarian Office Email
*
What are your top 2-3 training goals?
*
(i.e. General obedience training, eliminate alert barking, stop jumping, calm leash walking, etc.)
Have you tried any kind of professional training before? If so, what did you try and how did it work?
*
How would you describe your dog’s personality in your own words?
*
When stressed or fearful, my dog is
*
Select all that apply
My dog has been known to
*
Select all that apply
My dog can be
*
Select all that apply
Other
My dog plays well with
*
Select all that apply
Other
My dog plays well in the following ways
*
Select all that apply
Other
Is your dog sensitive to human touch?
*
If yes, on which parts of their body?
Has your dog ever bitten a person before?
*
If yes, please explain
Has your dog ever bitten another dog, or another animal?
*
If yes, please explain
Has your dog displayed any aggressive behavior?
*
If so, please explain
My dog is
*
Select all that apply
Other
When home alone, my dog is
*
Select all that apply
Other
How often do you walk your dog and for how long
*
What makes your dog the happiest?
Anything else we should know about your dog?
