Dog Training Form

Owner Information
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
How Did You Hear About Us?*
What Service Are You Interested In?*
How Many Adults Live At Home?*
Have You Ever Owned A Dog?*
How Many Children Live At Home?*
Have You Ever Trained A Dog?*
Please Describe The Reason For Contacting Us*
Dog Information
Dog's Name*
Breed*
Age*
How Old Was The Dog When You Acquired It?*
How Long Have You Owned The Dog?*
Where Did You Acquire Your Dog?*
Gender*

MaleFemale
Has Your Dog Been:*

SpayedNeuteredNone of the Above
If so, at what age?
Where Does Your Dog Sleep At Night?
Is Your Dog House Trained?
Is Your Dog Current On All Vaccinations Including Rabies, DHPP and Bordetella?*

YesNo
Can you provide documentation if necessary?*

YesNo
Please List Any Medical Problems Your Dog Has Had:*
How Many Dogs Are In The Household?*
Behavior Information
Describe Any Previous Obedience Training:*
Name of Trainer/Facility?*
How Long Did You Participate In This Training Program?*
When Was This Training Program?*
Level Of Success?
Which Member Of The Family Has The Best Control?*
Does Your Dog Know How To Walk On A Loose Leash?*

YesNo
Behavior Problems:*

Jumping UpChewingDiggingBarkingHowlingWhiningUrinatingStool EatingTail BitingTail ChasingStaringAggression
Describe Unwanted Behavior In Greater Detail:*
Do You Use A Crate?*

YesNoAt Night OnlyIn The Past But No Longer Use
Please Describe When Your Dog Appears Fearful, Anxious or Aggressive:
Do You Ever Muzzle Your Dog For Safety?*

YesNo
Is Anyone In Your Family Afraid Of Your Dog? If So, Please Describe:*
How Does Your Dog Respond To The Following Situations?
When Approached While Eating:*
When Approached With Treat Or Toy:*
When Dog Is Scolded:*
When Dog Is Pushed Off Furniture Or Bed:*
When Dog Is Approached While Sleeping:*
To Strangers Outside Of The House:*
To People Entering House/Yard:*
To Children Or Infants:*
While In Car To People Outside Of The Car:*
To Other Dogs In Your Home:*
To Other Dogs Outside Your Home:*
Is Your Dog Ever Aggressive To Family Members?*

YesNo
Has Your Dog Ever Bitten A Person?*

YesNo
Has Your Dog Ever Been Reported To Animal Control For Biting?*

YesNo
Trainer Notes

Please Leave this Section Blank
Should be Empty:

Trainer Notes