Dog Training Form

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?*
How Many Children Do You Have?
Have You Ever Owned A Dog?*
Have You Ever Trained A Dog?*
Briefly State What You Hope To Accomplish In This Class:*
Dog Information
Dog's Name*
Breed*
Age*
How Old Was The Dog When You Acquired It?*
Gender*

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

SpayedNeuteredNone of the Above
Where Did You Acquire Your Dog?*
Where Does Your Dog Sleep At Night?
Is Your Dog House Trained?
Behavior Problems Of Parents Or Littermates, if Known?
Veterinary Information
Veterinarian
Vet Clinic
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is Your Dog Current On All Vaccinations Including Rabies?*

YesNo
Vaccination Dates:
Rabies:*
DHLP:*
Please List All Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc*
Please List Any Medical Problems Your Dog Has Had:*
Behavior Information
Describe Any Previous Obediance Training:
Level Of Success?
What Commands Currently Work Best?
Which Member Of The Family Has The Best Control?
Does Your Dog Know How To Walk On A Leash?*

YesNo
How Does Your Dog Respond To The Following Tasks?
Trimming Nails?*
Giving Pills?*
Cleaning Ears?*
Grooming?*
Bathing?*
Patting Head?*
Grasp Collar?*
Being Lifted?*
Rolling Over*
Tell Me About Any Correction Techniques You Have Used And Their Effect On Your Dog’s Behavior:
Time Out*
Leash Correction*
Verbal Scolding*
Noisemaker*
Water Spray*
Rollover*
Other*
Other Description, If Needed:
Behavior Problems:*

Jumping UpChewingDiggingBarkingHowlingWhiningUrinatingStool EatingTail BitingTail ChasingStaringAggression
Describe Unwanted Behavior In Greater Detail:*
Do You Use A Crate?*

YesNo
Does Your Dog Like The Crate?*

YesNo
Does Your Dog Exhibit Any Of The Following Behaviors, and When Does It Occurs (With Men Or In The Car)
Cowering
Ears Back
Tail Tucked
Retreating
Hiding
Excessive Salivating
Pacing
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:*
Service Dog Handler Information
What are the three tasks you require from your service dog?
What is your medical condition, for requiring a service dog?
TERMS AND SERVICES

The trainer is highly allergic to scented products and will have her service dog present. If the service dog alerts to the trainer, the trainer has full rights to cancel the client who is wearing the scent and will reschedule them for another time. This is for the health and safety of the trainer. There is a zero tolerance for scented products.
By Clicking The Submit Button You Agree To The Above Terms
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Service Dog Handler Information