Pre-Consultation 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 Support SessionsTransformation PlanStay & Play Jump Start Transformation Plan
Dog Information
Dog's Name*
Breed*
Age*
Gender*

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

YesNo
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
List your top 3 training goals for your dog. *
Describe Any Previous Training such as Basic Obedience, Group Class, Private Lessons, ect..( please include a company/trainer name if so) :
Current Behavior Struggles:*

Excessive JumpingExcessive ChewingExcessive DiggingExcessive Barking/WhiningSeparation StrugglesUrinating in the houseStool EatingTail Biting/ Excessive Tail ChasingReactivity towards other dogsReactivity towards humansRecall strugglesPulling on leadGeneral AnxietyHyperactivityStealing/Counter SurfingExcessive Chasing (animals, people, vehicles, ect..)Other
Describe any Unwanted Behavior In Greater Detail:*
Tell Me About Any Correction Techniques You Have Used And Their Effect On Your Dog’s Behavior (ie, spray bottles, shaker bottles, training collars....):
*
Do You Use A Dog Crate?*

YesNo
Does Your Dog Like The Crate?*

YesNo
Do you have other pets in the home? If so, what species and how many?:*
Do You Ever Muzzle Your Dog For Safety?*

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