Dog Training and Behavior Intake Form First Name Last Name Email Phone Number Address Zip Code Date of appointment (if already set) I am interested in Private Training Day Training Walk & Train Not Sure Dog's Name Age Date of birth Weight (approx) Breed/Mix Sex Male Female Neutered/Spayed Yes No At what age? Any behavioral changes after neutering? Yes No If Yes, please describe Where did you acquire your dog? Stray/found Breeder—serious show/performance breeder Breeder—backyard breeder SPCA/Humane shelter Breed rescue service Other rescue Friend At what age? Your experience level First time owner Somewhat experienced (have had a few) Very experienced What information, if any, do you have about his/her previous life? Yes No What is your dog's activity level in general? (Choose one) Low Average High Excessive Veterinarian's name, address and phone number Is your dog taking any medication? If so, please list Does your dog has any health issues? If yes, please specify Any recent surgeries or injuries? Yes No If yes, please specify (include date) Does your dog have any allergies? Yes No If yes, please specify Any ear issues? Any skin issues? Yes No Please list each family member living in the home (include sex and age of children) Describe briefly how your dog gets along with each family member including any problems Please list all other pets living at home, including species, breed, age, and sex Describe how your pets get along with each other Have you moved since acquiring your dog? Yes No If yes, how many times Has your household changed since acquiring your dog? Yes No If Yes, how so? Death of human in family Death of pet in family Divorce Marriage Baby born Child moved Pet added Family moved Family schedule changed (lost or gained jobs) Other What do you feed your dog? (Please be specific, e.g., brand name) How much and at what time(s) do you feed your dog? Please be specific What is your dog’s favorite reward? Other than food, what rewards (e.g., toy, affection) would be most enticing to your dog? Does your dog have any dietery restrictions? Yes No If yes, please specify Where does your dog sleep? Have you ever used a crate for confinement? If yes, describe the crate and location Does your dog go to daycare or have a dog walker? Activities your dog likes Briefly describe the usual daily schedule for the family: What is your dog’s obedience school/training history? No school—trained yourself No training Puppy kindergarden Group lessons—basic Group lessons—advanced Private trainer at house Private trainer—sent to trainer Clicker training Remote collar training Prong/chocked chain training Reward-based training Agility Age when dog started lessons/training Is there any on-going training? Yes No Training equipment used No-pull harness Body harness Buckled collar Martingale collar Head harness (gentle, leader, halti) Chain collar Prong collar Remote control collar Which exercises will your dog do when asked? Come (Recall) Sit Down Stay Leave it Wait Polite Walking Other When you go out is your dog crated, confined or loose in a house? Please indicate what areas are restricted: How many hours is your dog left alone on the average day? Does your dog exhibit any signs of distress when left alone at home? Yes No Has your dog ever displayed any listed behavior to another dog or a person? Growl Snap (no skin contact) Bite (teeth mark) Bite (bruise/penetration) If so, please explain: How your dog reacts to petting/handling/restrain? No aggression Growl Snap (no skin contact) Bite (teeth mark) Bite (bruise, penetration) Not applicable (dog has never been in that situation) Put collar/leash/harness on or take off No aggression Growl Snap (no skin contact) Bite (teeth mark) Bite (bruise, penetration) Not applicable (dog has never been in that situation) How your dog reacts to pushing or pulling off furniture? No aggression Growl Snap (no skin contact) Bite (teeth mark) Bite (bruise, penetration) Not applicable (dog has never been in that situation) How your dog reacts to being disturbed while resting or sleeping? No aggression Growl Snap (no skin contact) Bite (teeth mark) Bite (bruise, penetration) Not applicable (dog has never been in that situation) How your dog react to towel feet when wet? No aggression Growl Snap (no skin contact) Bite (teeth mark) Bite (bruise, penetration) Not applicable (dog has never been in that situation) How your dog react to cars, bicycles, skateboards Calm Excited Fearful Friendly Aggressive Does your dog react to any of the listed noises? Check all that apply Thunderstorms Fireworks Gunshots Vacuum cleaner Leaf blower Weed whakers Dump trucks Sirenes Alarm systems Other noises If yes, please describe Please describe your dog's behavior problems, in as much detail as you wish When did the problem begin? What age was your dog when this problem started? What do you think caused the problem? Has there been a recent change in frequency or severity? Y/N If yes, describe What has been done to work on the problem(s)? What was your dog's response? Do you know whether your dog ever suffered a traumatic event? An attack by another dog or an issue with a human? If so, please explain Are there any other problem or challenges you are experiencing with your dog? What makes your dog get excited? What are your goals for your dog? Is there anything else you think we should know? Where did you hear about our services? Submit
