First Name
Last Name
Email
Phone Number
Address
Zip Code
Date of appointment (if already set)
Dog's Name
Date of birth
Weight (approx)
Breed/Mix
At what age?
How long have you had your dog?
What do you know about your dog's life before you acquired them?
Veterinarian's name, address and phone number
Is your dog taking any medication? If so, please list
Any allergies or ongoing medical concerns? Examples: skin allergies, ear infections, digestive issues, joint pain.
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
How does your dog interact with each family member? (any concerns, fear, guarding, rough play, etc.)
What is your dog’s favorite reward?
Other than food, what rewards (e.g., toy, affection) would be most enticing to your dog?
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?
What activities does your dog enjoy? (walks, hikes, fetch, tug, swimming, sniffing, etc.)
Briefly describe the usual daily schedule for the family:
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?
Please describe the incident(s)
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 are your goals for your dog?
What would success look like for you after training?
Is there anything else you think we should know?
Where did you hear about our services?
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