New Client Intake Form
Owner Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Dog Name
*
Breed
*
Age
*
Sex
*
Please Select
Male
Female
Spayed or Neutered
*
Please Select
Yes
No
Intact
Referred by:
Leave blank if not applicable.
Description of behaviors or training needs:
*
Select all that apply for behaviors you are wanting to address:
*
Jumping up on people
Counter surfing
Chewing on items
Mouthing on hands/clothes
Potty Training
Reactivity to people or dogs
Pulling on leash
Reactivity on leash
Barking
Growling
Biting/Snarling/Snapping
Guarding/Possession Behaviors
Anxiety
Separation Anxiety
Aggression to people
Aggression to other dogs
Aggression to other animals
Running off/not coming when called
Sensitivity to handling/grooming/bathing/brushing/nail trimming
Issues riding in car
Issues at veterinarian, that may require muzzling or meds
Lack of response to sit, down, stay, etc.
Has this dog aggressively bitten a person or another dog?
YES
NO
Name of Veterinary Clinic & Veterinarian
*
Proof of Vaccinations: DHLPP, Rabies, Bordetella. These vaccines must be current/ up to date at least 14 days before date of first session.
*
Browse Files
Drag and drop files here
Choose a file
** If puppy isn't fully vaccinated, please upload current vaccination records. Please refer to contract for full details on vaccination policy.
Cancel
of
Please select which days work best for scheduling training: Day and time will be confirmed in further communication.
*
Monday Evening
Tuesday Evening
Wednesday Evening
Thursday Evening
Other
Submit
Should be Empty: