Intake Form

Owner Information

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail

How Did You Hear About Us?

Have You Ever Trained A Dog?

Briefly State What You Hope To Accomplish With This Program:

Dog Information

Dog's Name

Breed

Age

How Old Was The Dog When You Acquired It?

Gender

How Long Have You Owned The Dog?

Has Your Dog Been:

Where Does Your Dog Sleep At Night?

Is Your Dog House Trained?

Veterinary Information

Veterinarian

Vet Clinic

Address

Street Address

Street Address Line 2

CityState / Province

Is Your Dog Current On All Vaccinations Including Rabies?

Vaccination Dates:

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?

Does Your Dog Know How To Walk On A Leash?

Describe Unwanted Behavior In Detail:

What Is Your Dog's Reaction To Your Departure?

What Is Your Dog's Reaction To Your Homecoming?

Do You Use A Crate?

Does Your Dog Like The Crate?

Do You Ever Muzzle Your Dog For Safety?

Is Anyone In Your Family Afraid Of Your Dog? If So, Please Describe:

Has Your Dog Ever Bitten Anyone? If So, Please Describe The Situation in Detail.

By Clicking The Submit Button You Agree That The Above Information Is True And Correct To The Best Of My Knowledge