Your Name:
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First Name
Last Name
Email
Phone:
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(###)
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Address:
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Household Members:
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Please include name, ages, and relationship with your dog
Other Pets:
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Please include pets that live in the house or have regular interaction with your dog. Include name, age, and breed/species, and if they are spayed/neutered.
Your Dog's Info:
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Please include your dog's name, date of birth and/or age, breed, weight, gender, and if they are spayed/neutered (and at what age).
Where did you get your dog?:
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Breeder
Humane Society/Shelter
Rescue Organization
Family Member
Other
If you answered "other", please describe:
How old was your dog when they joined your family?:
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What factors helped you choose this dog or breed of dog?:
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What are your training goals?:
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Please include behaviors you are looking to address and any activities you would like to pursue (sports, therapy dog, CGC, etc...)
For specific behaviors - when did you first notice these behaviors start?:
For example, if your dog is displaying reactive behaviors on leash, when did these behaviors begin?
Has your dog had any prior training?:
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Please include information about any training done at home or with a professional trainer.
What training methods have you used or are you currently using?:
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This includes positive reinforcement, clicker training, e-collar training, etc...
What equipment/tools do you currently use with your dog?:
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This includes things like regular collars, harness, prong collars, choke chains/slip leads, e-collar, gentle leader, etc...
Is your dog crate trained?:
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Even if you no longer use the crate!
Please describe your dog's typical routine:
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Include time spent alone/in crate, exercise routine, eating habits, any favorite activities, etc...
Does your dog have any history of aggressive or reactive behaviors towards dog or people? If yes, please describe.
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This includes barking, growling, lunging, snapping, biting, etc...
Does your dog have a bite history? If yes, please describe in detail - area of bite, severity, what occurred before/after the incident, etc...
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This does not include normal puppy teething/biting.
Name of Veterinary Clinic/Doctor:
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Date of Last Exam:
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Is your dog current on all vaccinations?:
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Please include due dates for current vaccines.
Does your dog have any known medical issues, including food allergies?:
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Is your dog currently taking any medication?:
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Please include things like supplements, daily medications, flea & tick medication, etc...
Any other important information on your dog:
