Obedience & Behavior Training Background
Date of your Private Lesson / Behavior Consultation
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Month
-
Day
Year
Date
Family Data
Name
*
First Name
Owner's Last Name
Address
*
Address
Street Address Line 2
City
State
Zip
Phone Number #1
*
Please enter a valid phone number.
Phone Number #2
Please enter a valid phone number.
Email
*
example@example.com
In which type of neighborhood do you live?
*
City
Suburban
Rural
10+ Acres
Please list the names of family members at home and children's ages
*
How did you hear about Misty Pines?
*
What is the name of your Veterinary facility and the name of your Veterinarian?
*
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Pet's Background
Pet's Name
*
Pet's Breed
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Pet's Age
*
Pet's Birth Date
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Month
-
Day
Year
Date
Pet's Sex
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Male
Neutered
Female
Spayed
At what age was your pet spayed/neutered?
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How old was your pet when you obtained it?
*
Where did you obtain your pet?
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Breeder
Shelter
Friend
Other
Why did you select this dog?
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Cute
Felt Sorry
Companionship
Working
Rescue
Breed
Other
Is this your first dog?
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No
Yes
If no, how many other dogs have you owned?
Do you currently have other pets in your home?
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No
Yes
If yes, what species and age ?
Were these pets in your household when you acquired this dog?
No
Yes
Where does your dog primarily live?
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Inside
Outside
Where does your pet sleep at night?
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Is your dog crate trained?
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No
Yes
Do you still use a crate?
No
Yes
What room is the crate in?
Do you have a fenced in yard?
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No
Yes
If yes, is the fence
Physical barrier
Invisible/Electronic/Underground
Does your dog have free access to all areas of your home?
*
No
Yes
If yes, when?
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Diet
What brand of diet do you feed?
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What type of food is it?
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Dry
Moist
Raw
Human/Table Food
If you feed human/table food, what food do you give?
How often do you feed your dog?
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Once
Twice
Three
Free Feed
Treats
Who feeds the dog?
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What is your dog's eating style
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All day grazer
Consumes food in 5 10 minutes or less
Very picky
Other
What, if any, supplements do you give your dog? List type and dosage.
What, if any, medications do you give your dog? List type and dosage.
Please state why your dog takes these supplements and/or medications.
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Obedience Training
Have you trained other dogs?
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Yes
No
If yes, where?
What did you learn?
What kind of training have you done with this dog?
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None
Some basics
Attended Classes
If you've attended classes, where did you attend?
How do you reinforce the dog?
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Food
Praise
Toy
Other
Will your dog work without treats/bribes (verbal commands alone)?
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No
Yes
Sometimes
How do you reward your dog?
*
Will your dog willingly...
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Sit
Down
Side
Stay/Wait
Not pull
Heel
Come
Fetch
Leave it
Take/Give
What does your dog like to work for? What motivates your dog?
*
Food
Ball
Stuffed/Squeak Toy
Toy
Praise
Petting
Nothing
Other
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Pet's Behavior/Socialization
PET'S BEHAVIORISOCIALIZATION (check all that apply)
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Flat
Buckle
Gentle Leader
Scruffy Guider
Chain/Prong
Electronic
Other
Does/Is your dog? (Check all that apply)
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House soils
Mouthing
Pulls on the leash
Chews
Digs
Unruly
Barks Excessively
Jumps Up
Runs Away
Charges the door
Counter Surfer
Fearful
Chases Cats
Other
Growls at Dogs
Growls at People
Other
Is your dog possessive of...
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Toys
Treats
Food
Bed
Stolen Objects
Other
Does your dog become aroused/anxious around...
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Med
Women
Children
Dogs
Cats
Other
Do you take your dog to dog park?
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No
Yes
How often?
How often is your dog around dogs outside your household (non-family dogs) and for how long?
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Never
Daily
Weekly
Occasionally
How many minutes or hours at a time?
How does your dog react at the Vets office?
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No Reaction
Shaking
Dilated pupils
Panting
Whining/crying
Growling/biting
Other
Is your dog presently on medication?
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No
Yes
If Yes, what medication and why?
Has your dog ever bitten another dog?
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No
Yes
How many times?
How severe?
Break Skin
Stitches
Bruising
Has your dog ever bit a person
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No
Yes
How many times?
How severe?
Break Skin
Stitches
Bruising
Please explain the circumstances for any bites.
What do you correct your dog for?
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How do you correct/punish your dog?
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Who corrects/punishes the dog?
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What obedience/behavior problems are we addressing today? (1)
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When did you first notice this problem? (1)
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What obedience/behavior problems are we addressing today? (2)
When did you first notice this problem? (2)
What obedience/behavior problems are we addressing today? (3)
When did you first notice this problem? (3)
Are there any specific situations that seem to trigger these behaviors? Please describe.
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Can the dog be interrupted when engaged in the behavior?
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No
Yes
Describe what you have done to try to stop the behavior:
*
What does your dog do when you try to stop the behavior?
*
How long is the interval between the behavior stopping and the beginning of the next occurrence?
*
Please describe the last time this problem occurred?
*
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Exercise
Describe what exercise your dog gets on a daily basis. Be specific.
*
How do you play with your dog?
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Fetch with ball, stick or other toy
Tug with rope or other
Chase
Rough house
Hide toys for them to find
Do not play
How long do you engage in playing with your dog each day?
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None
10 mins
30 mins
1 hr
2-3 hrs
3+ hrs
Do you take daily walks with your dog?
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No
Yes
If yes, how many?
If yes, how long is each walk?
Do you run your dog off-leash?
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Yes
No
How often?
How much time do you devote to training your dog?
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5-15 min/day
15-30 min/day
30 min/wk
1 hr/wk
Classes only
Private Lessons only
Don't know
What type of training are you interested in?
*
Continued Private Lessons
Group Classes
2 Week Boot Camp
None
Don't Know
How do you feel about your dog at this time?
*
List specific problem areas you with us to work on:
*
What is your primary goal for training?
*
What is your secondary goal for training?
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