Dog Training intake

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?*
Are There Children in the home? If yes, how many, and how old are they?*
Have You Ever Owned A Dog?*
How have you trained dogs in the past? Have you worked with a trainer previously?*
Briefly State What You Hope To Accomplish with This Dog:*
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
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
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:*
Has Your Dog Ever Bitten A Person?*

YesNo
Has Your Dog Ever Been Reported To Animal Control For Biting?*

YesNo
Should be Empty: