Intake Form
Owner information
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
County
Eircode
Phone Number
*
-
Children in the house under age 18?
*
Yes
No
If yes, names and ages of all children
Information about your dog
Dog's Name
*
Age / Date of Birth
*
If known
How long have you had the dog?
Sexual status
*
Spayed / Neutered
Entire (un-altered)
Breed (or cross-breeds if known)
Where does the dog eat?
Brand dog food
*
Dog's main food source (tick all that apply)
Dry Food / Kibble / Nuts
Wet / tinned food
Home cooked dog meals
Raw dog food diet
Scraps / table scrapings / leftovers
Other
What times does s/he eat?
Does your dog have any food allergies
*
Yes
No
Unknown
Please list any known allergies
Does the dog finish the meal straight away?
Yes
No
Is anyone (or other pets) nearby when the dog eats? Who?
How many walks per day/week
*
How long is each walk?
Play during the day
Tug
Fetch
Chase (people)
Roughhousing/wrestling
Other
How long does the dog get played with every day?
*
What would you like your dog to learn to do
*
Housetraining/ appropriate toilet behaviour
Eye contact / name recognition
Accept handling and grooming
Walk on loose lead
Go to bed / crate training
Sit
Lie Down
Stay
Drop
Leave it
Come Here / Recall
Other
Anything you would like the dog to learn not listed above
What would you like your dog to stop doing
Jumping on visitors / people
Puppy or play nipping
Bolting out the door
Digging
Inappropriate chewing
Growling
Biting (aggressive / defensive - not in play)
Excessive barking
Lunging at people/dogs/cars on walks
Other
If you selected Biting, barking, lunging or growling, please describe in detail when these are happening
You may be asked to fill in a behavioural questionnaire based on your answer
Anything you would like your dog to stop not listed above
What equipment are you currently using
*
Bed on floor
Crate
Flat Collar
Body Harness
Slip lead / choke chain
Fixed length lead
Flexi lead
Long-line or tracking line (5 meters or more)
Prong collar
Electric / stim / vibration collar (or invisible fencing)
Thundershirt
Adaptil plug in
Other
What are your dog's 3 favourite snacks/treats
*
What are your dog's 3 favourite toys/game
What enrichment toys/food puzzles do you have (eg., Kong)
if any
What tricks/cues/commands does your dog already know
Sit
Stay
Come Here
Fetch
Drop
Lie Down
Go to bed / go to place
Other
How were these taught (select all that apply)
*
Don't know / unknown
Luring (showing the dog food to get into position, then feeding)
Moulding (placing hands on dog to guide into position)
Praise
Reinforcement (saying cue/command then rewarding with food or play after achieved)
Saying 'no'
Shouting
Spray bottle
Rattle can / startle device
Tipping on nose
Scolding
Slapping / hitting or other physical punishment
electronic collar
Other
For unwanted behaviours, what happens right before the dog does it?
eg., someone walks past window then the dog barks, or visitor arrives at door, dog jumps
Please describe your dog's day in detail from waking in the morning to going to sleep at night. Include toilet breaks, play, walk, naps, time left alone, etc.
*
Where did you hear of us
Google
Facebook
Vet
Friend
Pet Shop
Other
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