Consultation Form Inquiry

Owner Information
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
E-mail *
How Did You Hear About Us? *
How Many Children Do You Have? *
Have You Ever Owned A Dog? *
Have You Ever Trained A Dog? *
Briefly State What You Hope To Accomplish In This Class: *
Dog Information
Dog's Name *
Breed *
Age *
How Old Was The Dog When You Acquired It? *
Gender *

Male Female
How Long Have You Owned The Dog? *
Has Your Dog Been: *

Spayed Neutered None of the Above
Where Did You Acquire Your Dog? *
Where Does Your Dog Sleep At Night?
Is Your Dog House Trained?
Behavior Problems Of Parents Or Littermates, if Known?
Veterinary Information
Veterinarian
Vet Clinic
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Is Your Dog Current On All Vaccinations Including Rabies? *

Yes No
Vaccination Dates:
Rabies: *
DHLP: *
Please List All Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc *
Please List Any Medical Problems Your Dog Has Had: *
Behavior Information
Describe Any Previous Obediance Training: *
Level Of Success? *
What Commands Currently Work Best? *
Which Member Of The Family Has The Best Control? *
Does Your Dog Know How To Walk On A Leash? *

Yes No
How Does Your Dog Respond To The Following Tasks?
Trimming Nails? *
Giving Pills? *
Cleaning Ears? *
Grooming? *
Bathing? *
Patting Head? *
Grasp Collar? *
Being Lifted? *
Rolling Over *
Tell Me About Any Correction Techniques You Have Used And Their Effect On Your Dog’s Behavior:
Time Out *
Leash Correction *
Verbal Scolding *
Noisemaker *
Water Spray *
Rollover *
Other
Other Description, If Needed: *
Behavior Problems: *

Jumping Up Chewing Digging Barking Howling Whining Urinating Stool Eating Tail Biting Tail Chasing Staring Aggression
Describe Unwanted Behavior In Greater Detail: *
Describe How Your Dog Reacts To The Following Times When Left Alone:
During The Day:
During The Evening:
What Is Your Dog's Reaction To Your Departure?
What Is Your Dog's Reaction To Your Homecoming?
Do You Use A Crate?

Yes No
Does Your Dog Like The Crate?

Yes No
Does Your Dog Exhibit Any Of The Following Behaviors, and When Does It Occurs (With Men Or In The Car)
Cowering *
Ears Back *
Tail Tucked *
Retreating *
Hiding *
Excessive Salivating *
Pacing *
Please Give Additional Information Regarding Fear Or Anxiety In Your Dog: *
Describe Situations Where Your Dog Appears Fearful And/Or Aggressive: *
Do You Ever Muzzle Your Dog For Safety? *

Yes No
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: *
Ever Aggrieve To Family Members? *

Yes No
Has Your Dog Ever Bitten A Person? *

Yes No
Has Your Dog Ever Been Reported To Animal Control For Biting? *

Yes No
Should be Empty:

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