The Eye Of The K9 - Canine Assessment
Email
example@example.com
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation
Preferable Contact Time
Morning (8am -12pm)
Afternoon (12pm - 4pm)
Evening (5pm - 8pm)
Weekend
Preferable Training Time
Morning (8am - 12am)
Afternoon (12am - 4pm)
Evening (5pm -8pm)
Weekend
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How Did You Find The Eye Of The K9?
How did you hear about our services
Friend
Family member
Social media/internet
Other
If you selected “Other” explain how
What is your reason for wanting your canine trained?
Are you willing to participate in a video recorded interview for our website and social media?
Yes
No
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Canine Information
Pet Name
Date Of Birth
-
Month
-
Day
Year
Date
Weight
Sex
Male
Female
Breed
Color
Age Obtained/Year
Veterinarian's name (We require this information, in the event we need to get additional information regarding your pet).
Veterinarian's Phone number (We require this information, in the event we need to get additional information regarding your pet)
Veterinarian's Address (We require this information, in the event we need to get additional information regarding your pet)
When was your pets last Vet Visit?
Does your pet have any medical problems?
Is your pet on any medication?
Neutered / Spayed
Neutered
Spayed
N/A
Any changes after neutering?
Choose what best describes your dogs personality
Quiet
Confident
Unruly
Bold
Other
If you selected “Other” please explain
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Home Environment
Type of food
How often is your pet fed?
Where is your pet fed?
How often do you give your pet treats?
Type of treat(s) if any:
When do you give treats?
Do you have any other pets?
Yes
No
Describe how your pets interact with each other
How many family members live in the household?
Do you see your dog is a pet or family member?
Pet
Family Member
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Daily Activities & Routines
How often does your canine get exercise/play?
Favorite game(s):
Where does your dog sleep at night?
Have you ever used a crate for confinement?
Yes
No
If you selected, yes describe crate location
Describe the dogs reaction to being crated
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Departure Behavior Screening
When you go out, is your dog confined or crated?
Please Select
Yes
No
Describe if crated or what areas are restricted:
If you previously used a crate and stopped explain why:
How does your canine react when you prepare to leave?
Is your canine left alone outdoors?
Yes
No
How long is your canine left alone on the average day?
How long (average)?
Where is your canine left when outdoors?
How did your canine react to being left alone outdoors?
How often?
How long (average)?
Where is your canine left when outdoors?
How does your canine react to being left alone outdoors?
Previous Training
Has your canine ever received obedience training?
Group Training
Private Training
I Trained My Pet At Home
N/A
Describe the training your canine has received including the previous trainers name if applicable:
Has your canine received off leash training?
Yes
No
What equipment do you use on your canine?
Basic Collar
Training/Prong Collar
E-Collar
Bark Collar
Slip Lead
Chain Collar
N/A
If equipment is/was used describe how and why?
How would you describe the previous training?
Reward Based
Assertive/Domineering
Adversive/Mostly Corrective
Equipment Based
Other
If other describe below
Briefly describe the training techniques:
Rows
Yes
No
Jumps on (owners)
Jumps on (strangers)
Won’t come when called
Nips/Grabs with mouth
Chooses when and not to listen
Pushy/Demanding
Is your pet allowed on furniture?
Yes
No
Activity
Normal
Lazy/Inactive
Restless/Won’t Settle
High Active
Overactive
Sleep Habits
Normal
Increased
Less Frequent
Restless Sleep
Night Walking
Rows
Yes
No
Stool Eating
Garbage Raiding
Food Stealing
Eats Non Food Items (Pica)
Licks Objects
Digging
Chewing
Mounting
Roaming/Running
Humping
Barking
Howling
Whining
Repetitive/Compulsive/Unusual Activity (select all that apply)
Tail Chasing
Sucking
Star Gazing
Fly Chasing
Light Chasing
Staring
Hunting/Predation
Yes
No
Canine Assessment
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Canine Assessment Deposit
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