Client Questionnaire

Client Questionnaire
Owner's Name*

First NameLast Name
Address
Phone Number
Email
example@example.com
Please list the household family members that interact with your dog (if children, please list age)
Are you a new or experienced dog owner?

Brand new! This is our first dogHave had childhood dogs but did not really participate in their care/trainingI've had one or multiple dogs where I have been their primary caretakerThis is NOT my first rodeo! I've taken classes, participate in dog sports, dogs are my whole life!
Have you previously sought professional help with any of the behavior issues listed in this questionnaire?
How many days per week are you willing to work with your dog outside of sessions?

1-2 days2-4 days5 or more
What amount of time per day can you spend training?
About Your Dog
Dog's Name
Age/Breed
Sex

Neutered MaleSpayed FemaleIntact MaleIntact Female
When did you get your dog? What age were they?
Name of Breeder or Rescue
Describe previous homes (if applicable or known)
Daily Activities and Routine
What types of exercise/play does the dog engage in, and how often?
What household member provides the majority of the exercise and playtime?
Where does the dog sleep during the day? At night?
Briefly describe the family's typical daily schedule.
Dog's current food?
Favorite treats?
Any allergies?
Training
Has this dog had any obedience training? What commands does it know reliably?
What types of tools have you used on your dog? (harness, prong, flat buckle collar, slip lead/collar, e-collar, martingale, clicker, etc)
How did the dog respond to each?
What training techniques have you used in the past? Check all that apply.

Reward-basedAssertive/domineering (scruffing, alpha-rolling)Aversive/mostly correctionsCombination of reward and corrections
What training was most successful?
What training was least successful?
Describe your dogs learning ability/willingness to engage in training
Is there any ongoing training? Describe.
What family members have the most control?
What family members have the least control?
Who has worked with the dog the most?
For each of the following, use a scale of 1 (poor) to 5 (excellent) to indicate how your dog responds.
Sit
Sit/Stay 1 minute
Down
Down/Stay 1 minute
Come (indoors)
Come (in backyard)
Come (in park)
Heel/Loose leash walk (no distractions)
Heel/Loose leash walk (with distractions)
Give/drop it
Leave it
Does your dog know any tricks? (play dead, shake, roll over) Please list.
Can you get your dog to settle (calm down) on command? If yes, describe how:
Have you ever used the following for punishment/training?

If yes, please describe your dog's reaction. There is no shame here. Please be honest so that I can be as effective as possible
Physical punishment (hitting, spanking, kicking, etc)
Noise punishment (shaker can, etc)
Ultrasonic (bark collar)
Verbal reprimands
Water sprayer
Muzzle grasp (holding muzzle closed)
Alpha roll/pinning
Booby traps/repellants
Time out (crate, separate room)
What punishment(s) has been the most effective?
Does any punishment make the problem worse? If yes, describe.
Has punishment ever led to threatening behavior or aggression? Please describe.
Does your dog respond differently to punishment from different family members? Please describe.
How does your dog react to the following:
Nail trimming
Brushing
Bathing
Teeth brushing
Ear cleaning
Giving pills/liquid meds
Grabbing collar
Hugs/kisses
Head pets
Rubbing belly
Being lifted
Indicate how your dog reacts to each of the following (Check all that apply)
Familiar dogs on property

CalmExcitedAmbivalentFearfulFriendlyAggressive
Familiar dogs off property

CalmExcitedAmbivalentFearfulFriendlyAggressive
New dogs on property

CalmExcitedAmbivalentFearfulFriendlyAggressive
New dogs off property (on leash)

CalmExcitedAmbivalentFearfulFriendlyAggressive
New dogs off property (off leash)

CalmExcitedAmbivalentFearfulFriendlyAggressive
Strangers outside on property

CalmExcitedAmbivalentFearfulFriendlyAggressive
Strangers off property (on leash)

CalmExcitedAmbivalentFearfulFriendlyAggressive
Strangers off property (off leash)

CalmExcitedAmbivalentFearfulFriendlyAggressive
Strangers arriving at door

CalmExcitedAmbivalentFearfulFriendlyAggressive
Car rides

CalmExcitedAmbivalentFearfulFriendlyAggressive
Thunderstorms/Fireworks

CalmExcitedAmbivalentFearfulFriendlyAggressive
Other loud noises (shouting, door slamming, etc)

CalmExcitedAmbivalentFearfulFriendlyAggressive
Has your dog ever bitten someone? If yes, did it break the skin? Please describe what happened.
Has your dog ever bitten another dog, other than in play? If yes, did it break the skin? Please describe what happened.
What is your primary reason for seeking out a professional trainer? (Basic obedience, behavior modification, etc) What do you hope to get out of our sessions?
I work just as much with you as I do your dog. I need dedicated owners that work hard in between sessions, or we will have failed ourselves and the dog. Are you willing to follow instructions and guidelines, that I will lay out in a training plan?

YESNO
I hereby swear that all information above is correct and whole to the best of my knowledge, and that withholding information could lead to harm and injury to all parties involved.

Powered by Jotform SignClear
Should be Empty:

Client Questionnaire

About Your Dog

Daily Activities and Routine

Training

For each of the following, use a scale of 1 (poor) to 5 (excellent) to indicate how your dog responds.

Have you ever used the following for punishment/training?

How does your dog react to the following:

Indicate how your dog reacts to each of the following (Check all that apply)