Client Information Form

Client Information Form

To schedule an initial consultation, please fill out the form entirely. Please complete a separate form for each dog. Consultations will typically be scheduled for a date, 2-4 weeks after the form is submitted. Please answer the questions that follow as thoroughly as possible. All answers are confidential and will help me serve you better.
For more information about the initial consultation and subsequent training packages, please see https://laikadogtraining.com/training. I will get back to you as quickly as possible with available time slots. Thanks very much!!
Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Occupation
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
What is your availability? Please check all that apply:*

flexibleweekdays 10am-2pmweekdays 2pm-5pmweekdays 5pm-8pmweekendsOther
Type of Home*
Yard*
How did you hear about me?*
Dog's Name*
Dog's Date of Birth*

MonthDayYear
If unsure, please write approximate date.
Weight (Kg)*
Breed(s)*
Where did you get your dog?*
please list name of breeder or rescue organization if applicable
Photo of your dog:*

Please upload a photo of your dog
Cancelof

Medical Information and History
Veterinarian's name (office name) and phone number:*
Date and reason for last visit:*
Date last vaccinated and vaccines administered: *
Date of last blood test and abnormal findings if any:
Is your dog easily handled by vet staff?*

yesno
Has your dog needed to be muzzled at the vet?*

yesno
List any current health problems and medications: *
If None, type None
List past health problems and treatments:*
If None, type None
List any sensitivities or allergies including food and environmental:*
If None, type None
Which flea and tick preventative do you use?*
If None, type None
Which heartworm preventative do you use?*
If None, type None
Is your dog spayed/neutered? If so, at what age?*
If Intact, type No
Was your dog spayed/neutered for a behavioural or medical reason?

Medical Information and History