Client and Dog History Form
Please fill out the form entirely
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dog's Name
*
Dog's Date of Birth
*
-
Month
-
Day
Year
Date. If unsure, please guess approximate Date.
Approximate Weight
*
In Lbs.
Breed
*
Color
*
Sex
*
How long have you had your dog?
*
Where did you get your dog?
*
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Medical History and Information
Which flea and tick preventative do you use?
*
If None, type None
Which heartworm preventative do you use?
*
If None, type None
How old was your dog when he/she was spayed/neutered?
*
If Intact, type Never
Does your dog have or have they had any of the following conditions?
*
Rows
Currently
Has Had
Prone To
Never Had
Seizures
Bloat
Pancreatitis
Cushings Disease
Lyme Disease
Stress Colitis
Diabetes
Heart Condition
Does your dog have any allergies or skin conditions?
*
If None, type None
Are there any places your dog does not like to be touched?
*
If None, type None
Are there any medications your dog is taking?
*
If None, type None
Who is your primary Veterinarian?
*
If None, type None
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Personality, Preferences and Past Experiences
Which 3 adjectives best describes your dogs personality?
*
Calm
Easy-Going
Worried
Inquisitive
Patient
Affectionate
Needy
Protective
Goofy
Playful
Bossy
Intense
Vocal
Which best describes your dogs energy level?
*
Low
Medium
High
How would you describe your dog's play style with PEOPLE?
*
Fetch
Tug of War
Wrestling
No Thanks
Other
Are there any types of PEOPLE that your dog dislikes? Please explain.
*
If Not, type None
How does your dog initially act in these situations:
*
Rows
Fearful/Worried
Submissive/Hesitant
Calm/Relaxed
Excited/Barking
Dominant/Aggressive
Don't know
Greeting a stranger in Public
Interacting with Vet or Vet Tech
When a person reaches for your dog's collar or head
Being touched or approached with owner present
When hugged or lifted
When a person takes food, toys or prized objects
Interacting with other family dogs
Passing a calm dog on a leash
Passing an excited or barking dog on a leash
Does your dog have any problems in the following areas:
*
Mouthing
Jumping/Mounting other dogs
Housetraining
Barking
Chewing bedding
Destroying toys
Eating rocks/foreign objects
Has sensitive paws
Climbing fences
Ignoring commands
Other
Is your dog crate trained?
*
Yes
No
Is your dog potty trained?
*
Yes
No
Has your dog had any former training?
*
Yes
No
Is your dog reactive? If "Yes" please fill out "Other" and explain triggers.
*
No
Other
Is your dog aggressive? If "Yes" please fill out "Other" and explain triggers.
*
No
Other
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Final Details
Just a few more simple questions
Please provide other comments or information about your dog that you feel might be helpful:
Please list your concerns and what you hope to get out of training:
How did you hear about us?
*
Internet Search
Facebook
Instagram
Word of Mouth/From a Friend
Other
If referred by a friend, please tell us who so we can thank them:
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