Dog Training Questionnaire

Please fill out this form honestly and thoroughly. Answer as best as you can with your knowledge.

Please type n/a if the question does not apply to you and your dog.
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?*
What Program(s) are you interested in at this time?( You may select more than 1.)*

Online Course (No 1on1 support)Online Course with 1on1 SupportTransformation Plan w/ Board & TrainVirtual SessionsIn-Person Sessions
Dog Information
Dog's Name*
Breed*
Age*
Gender*

MaleFemale
How Long Have You Owned The Dog?*
Has Your Dog Been:*

SpayedNeuteredNone of the Above
Where Did You Get Your Dog? *
Is Your Dog House Trained? Meaning, he/she does not urinate or defecate in the house. *
Veterinary Information
Vet Clinic
Has your dog been given clean bill of health by a veterinarian in the past 6 months? *
Is Your Dog Current On Rabies, Distemper, Parvo, and Bordetella Vaccines?*

YesNo
Please List All Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc*
Does your dog have any food allergies or sensitivity? If yes, please list the foods. *
Please List Any Medical Problems Your Dog Has Had:*
Behavior Information
Describe Any Previous Training such as Basic Obedience, Group Class, Private Lessons, ect..( please include a company/trainer name if so) : *
Level Of Success?*
What Commands/Cues Currently Work Best?*
Does Your Dog Know How To Walk On A Leash without pulling?*

YesNo
Tell Me About Any Correction Techniques You Have Used And Their Effect On Your Dog’s Behavior:
Behavior Problems:*

Jumping UpChewingDiggingBarkingWhiningUrinating in the houseStool EatingTail BitingTail ChasingAggression towards other dogsAggression towards humansRunning awayOther
Describe any Unwanted Behavior In Greater Detail:*
What Is Your Dog's Reaction To Your Departure?*
What Is Your Dog's Reaction To Your Homecoming?*
Do You Use A Crate?*

YesNo
Does Your Dog Like The Crate?*

YesNo
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?*

YesNo
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 Pushed Off Furniture Or Bed:*
To Strangers Outside Of The House:*
To People Entering House/Yard:*
To Children Or Infants:*
To Other Dogs In Your Home:*
To Other Dogs Outside Your Home:*
Ever Aggressive To Family Members?*

YesNo
Has Your Dog Ever Bitten A Person?*

YesNo
If Yes, please describe the circumstances. What occurred to trigger bite? Did it puncture this skin or leave any bruising? Was it one bite or multiple bites? Did your dog latch on and not let go? Did he/she latch on and shake his/her head?*
Has Your Dog Ever Bitten another animal?*

YesNo
If Yes, please describe the circumstances. What occurred to trigger bite? Did it puncture this skin or leave any bruising? Was it one bite or multiple bites? Did your dog latch on and not let go? Did he/she latch on and shake his/her head?*
Has Your Dog Ever Been Reported To Animal Control For Biting?*

YesNo
Human Learning

All training programs have an element of human learning required. In fact, often the human end of the leash actually has more learning to do than the dog end.
Are you willing to make changes to your current daily routine, if that is what is determined to be in the best interest of your dog? (This may or may not include: crate training, temporarily discontinuing daily walks, discontinuing doggy daycare, changing how/when you feed your dog, ect..)*

YesNo
Are you willing to hold yourself accountable during the training period? (this may or may not include: devoting 15 to 30 minutes a day to playing games with your dog, keeping your dog on a leash inside the home, feeding from your hand instead of a bowl, discontinuing use of punishment, ect..)*

YesNo
I have answered all the questions honestly, thoroughly, and to the best of my knowledge.

I understand that no matter what training program I choose for my dog, I will also have things to learn during the process.

Just like a music teacher or fitness trainer, my dog trainer can not guarantee results, and it will be my dedication to the training program that will determine how successful my dog and I will be.
By Clicking The Submit Button You Agree To The Above Statement
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Human Learning