Private Sessions Intake Form

Private Sessions Intake Form
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Where did you hear of us?
Dog's Name
Dog's Age
If unknown please give an estimate
Dog's Breed
Dog's Sex

MaleFemale
Is your dog neutered/ spayed?
If YES, at what age did they get this?
How long have you had the dog?
Who is your dog's vet?
Please provide name of vet clinic
Does your dog have any medical issues?
If yes, please provide details
What was the reason for your last vet visit?
Is your dog on any type of medication?
If yes, please list them
Do you work with other dog professionals?
If so please provide details. This could include dog walkers, trainers, day cares, holistic therapists or anyone else working with your dog.
Has your dog had any previous training? (If yes, describe who did the training, training methods and type of training).
Ex puppy class, obedience training, reactive training etc.
What tricks / skills does your dog know?
Have you noticed any changes in your dog's behaviour?
Has your dog ever bitten another dog or human?
If yes, please provide details.
Does your dog lunge, growl or bark at people?

YesNo
Does your dog lunge, growl or bark at other dogs?

YesNo
What would you most like to change about your dog's behaviour? Name at least three things in order of importance.
Please provide as much detail as possible.
On an average day, how much exercise does your dog get? (Please be honest there is no wrong answer.)

NoneUnder 1 hour1 - 2 hours2 - 3 hours3 - 4 hours4 + hours
What is your dog's favourite activity?
What is your dog's least favourite activity?
Tell us about your dogs eating routine
Please list the brand and type of food along with how often you feed your dog. If you use treats please detail these too.
Does your dog have any time of food allergies?

YesNo
Is there anything else you wanted to add?
What time would you prefer?

EveningsWeekendsWeekday mornings (10am-12pm)Weekday afternoons (12pm-4pm)
Should be Empty: