the Behavior Questionnaire

Private Session

Intake Questionnaire
Please note: Private sessions are not for behavior problems. They are available to help you develop and/or refine manners your dog needs.
Today's Date

MonthDayYear
Date
Are you already a client?

YesNoYes, but its been awhile
Owner's Information

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
How many dogs are in your household?
How many dogs will you be bringing to your private lesson? Up to 2 permitted for the same session price, providing there is a second handler for the second dog.
Dog #1: Provide name, age, gender, breed or breed type, if spayed or neutered, how long you have had the dog. Where you acquired the dog.
For Dog #1, What training skill(s) do you need help with?
Dog #1
Any known information about the dog before you got he/she? Did the dog have any previous training? If so describe previous training. What basic commands does your dog(s) know? (such as sit or down). Any medical concerns or medications?
Dog #1
Describe dog #1's personality and temperament
Dog #1
Dog's primary diet: How often is dog fed? How much? What type of food? Does the dog receive enrichment toys or enrichment activities?
Dog #1
Dog #2: Provide name, age, gender, breed or breed type, if spayed or neutered, how long you have had the dog. Where you acquired the dog.
For Dog #2, What training skill(s) do you need help with?
Dog #1
Describe dog #2's personality and temperament
Dog #2
Any known information about the dog before you got he/she? Did the dog have any previous training? If so describe previous training. What basic commands does your dog(s) know? (such as sit or down). Any medical concerns or medications?
Dog #2
Dog's primary diet: How often is dog fed? How much? What type of food? Does your dog receive enrichment toys or enrichment activities?
Dog #2
List all people who live in the home (Name/age/relation to you)
Describe the activity level of your household - both people and pets
Are there other pets in the house? Give details.
How often do you have visitors/strangers?
Do any of your dogs attend a doggie daycare or visit a dog park?

NoYesOther (provide details below)
Details about daycares or dog park attendance.
Do any of your dogs have other known doggie friends that they play with in SMALL groups (not in a daycare or dog park environment)?

NoYes
Do you have a fenced yard?

YesNo
Do you walk your dog or dogs? How often and how far?
Is your dog or dogs crated?

YesNo
If yes, how often and how long at a time? Other details can also be provided here:
If crated or confined. Do you feel your dog or dogs are comfortable with confinement?

YesNoUnsure
Who is the person or persons in the household the dog or dogs listens to the best?
By submitting this form you agree and understand the following:

**Your appointment is not guaranteed/confirmed until tuition is received. Pre-payment is required.

**Session Refund/Re-schedule Policy**You have one week before your appointment to reschedule /cancel for a full refund/credit. If within 3 days, 50% will be refunded or credited. If within 24 hours, no refund or credit.

**Please bring your dog hungry and slightly exercised. Bring small, soft high value treats.

**For maximum benefit and success, we encourage everyone who lives/interacts/encounters your dog/dogs to attend your private session.
Please leave this area blank
Should be Empty:

Private Session

Please note: Private sessions are not for behavior problems. They are available to help you develop and/or refine manners your dog needs.