Private Sessions Intake Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone 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
Male
Female
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?
Yes
No
Does your dog lunge, growl or bark at other dogs?
Yes
No
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.)
None
Under 1 hour
1 - 2 hours
2 - 3 hours
3 - 4 hours
4 + 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?
Yes
No
Is there anything else you wanted to add?
What time would you prefer?
Evenings
Weekends
Weekday mornings (10am-12pm)
Weekday afternoons (12pm-4pm)
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