Private Training Intake Form

Owner Information

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

E-mail *

How Did You Hear About Us? *

Have You Ever Owned A Dog? *

Have You Ever Trained A Dog? *

Briefly State What Your Training Goals: *

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? *

Is Your Dog House Trained?

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

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 Obedience Training:

What Commands Currently Work Best?

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: *

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?

(Strangers, men, children, dogs, noises, in 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 Aggressive 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

Liability Waiver & Policies

(One Smart Dog, LLC) will endeavor to create as safe an environment as possible for the training of my dog and will offer only sound, safe, and responsible training and training instructions. However, to the extent that (One Smart Dog, LLC) is insured for any unintentional or negligent errors, omissions, or incorrect assertions, (One Smart Dog, LLC) will be responsible for any such acts or omissions, but only to the extent of such insurance. I have been told by (One Smart Dog, LLC) and understand the inherent risks of owning a dog, including but not limited to the risk of dog bites to myself or others, and consequently I am and will remain responsible for the actions of my dog at all times, and I hereby agree to indemnify and hold harmless (Dawn Lowery or One Smart Dog, LLC) of any and all claims of injury, expense, costs, or damages caused by my dog. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service.

*I agree to allow One Smart Dog LLC to contact my dog’s veterinarian to discuss behavior and medical history.

Photo and Video Release

I grant permission to One Smart Dog, LLC and its legal representatives and assigns, the irrevocable and unrestricted right to use, publish and broadcast my photograph(s), likeness and voice, including via video, for trade, advertising, and any other purpose and in any manner and medium; and to alter the same without restriction. I hereby release One Smart Dog, LLC and its legal representatives and assigns from all claims and liability relating to said photograph(s), video(s), likeness and voice.

NEW PAYMENT POLICY
Due to a fully booked schedule and 4-6 week wait list for appointments we have implemented a new payment policy for consultations and private training lessons starting 11/1/2021.

Once your appointment is booked you must prepay to reserve the time slot you have booked. If you need to cancel, you must give us 24 hours notice to get a refund or to reschedule. If not, you forfeit the time and there is no refund.

By Clicking The Submit Button You Agree To The Above Terms