Dog Training Refer Form

Owner Information - Please Put Unknown In Unanswered Questions

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip CodeCountry

Phone Number

MobileDay Time

E-mail

How Did You Hear About Us?

How Many Children Do You Have?

Have You Ever Owned A Dog?

Has Your Dog Ever Had Any Professional Training?

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

How Long Have You Owned The Dog?

Has Your Dog Been:

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

Postal / Zip CodeCountry

Is Your Dog Current On All Vaccinations Including Rabies?

Vaccination Dates:

1st

2nd

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?

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?

Does Your Dog Like The Crate?

Does Your Dog Exhibit Any Of The Following Behaviors, and When Does It Occurs (With Men Or In The Car)

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?

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?

Has Your Dog Ever Bitten A Person?

Has Your Dog Ever Been Reported To Animal Control For Biting?

By Clicking The Submit Button You Agree That All Information Given Is Correct