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

How Calm is your dog on a general basis? (How much of your dogs day is spent in a state of total relaxation? Calm dogs can settle quickly after an exciting or worrying event. Calm dogs make good choices. )*

	1	2	3	4	5

1 is Not Calm, 5 is Calm About Everything

How Confident/Optimistic is your dog? An Optimistic Dog: Sees Novelty (new/rare experiences) as something normal. Approaches everything with a happy life attitude. Overall is not bothered by much.*

	1	2	3	4	5

1 is Pessimistic/Worried , 5 is Optimistic/Confident

Rate your dogs skill of Disengagement: Disengagement is your dog’s ability to move away from things in the environment (and be happy to do so). It’s the skill of seeing things as “none of their business”. The ability to not fixate on something.*

	1	2	3	4	5

1 is Worst, 5 is Best

Rate your Dogs Dimmer Switch? Instead of having a “light switch” where they go from 0 (snoozing, minding their own business) to 100 (barking, lunging, growling, pulling) at distractions (like the mailman, other dogs, people, etc.). They’re able to pick an energy level that’s appropriate for any given situation. (pick their head up and go back to bed at the mailman, look at and ignore other dogs, Play when its play time, settle when its downtime. seek affection at a neutral level without acting like a wild child, etc..)*

	1	2	3	4	5

1 is Worst, 5 is Best

Rate your dog's level of Engagement with you. Engagement is the cornerstone of your relationship with your dog. It determines your dog’s ability to interact with you and the value they see in that interaction. The concept of Focus, or the skill of being able to choose you, is involved in engagement.*

	1	2	3	4	5

1 is Worst, 5 is Best

Rate your dog's Flexibility. Flexible dogs can adapt to different situations and go with the flow. Teaching our dogs the skill of flexibility allows them to make different choices when presented with the same situation and adjust their response in the face of the unpredictable. A flexible dog doesn't need a strict routine to be comfortable.*

	1	2	3	4	5

1 is Worst, 5 is Best

Rate your dogs Impulse Control. A dog with great impulse-control can still offer attention and follow cues around exciting things! Can listen, think and respond to you in the face of exciting distractions.*

	1	2	3	4	5

1 is Worst, 5 is Best

Rate your dogs Tolerance of Frustration. Tolerance of Frustration dictates how well your dog copes when they can’t have immediate access to something they want (toys, food, a dog in the distance, and in the case of separation struggles, YOU! Dogs with low levels of frustration tolerance, often show behaviors such as resource guarding, separation anxiety, or leash reactivity (reactivity when on leash, but not when off leash). *

	1	2	3	4	5

1 is Low Tolerance, 5 is High Tolerance

Rate your dog's Independence. (Independence determines whether your dog sees value in spending time away from you and is comfortable doing so) *

	1	2	3	4	5

1 is Velcro Dog, 5 is Too Independent

Describe Any Previous Training such as Basic Obedience, Group Class, Private Lessons, ect..( please include a company/trainer name if so) :
Level Of Success?
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....):
List your top 3 training goals for your dog. *
Do You Use A Dog Crate?*

YesNo
Does Your Dog Like The Crate?*

YesNo
Please Give Additional Information Regarding Fear, Anxiety, or Aggressive Behaviors Your Dog Exhibits:
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
Is Anyone In Your Family Afraid Of Your Dog? If So, Please Describe:*
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