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

How Long Have You Owned The Dog?

Has Your Dog Been:

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?

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:

Describe Unwanted Behavior In Greater Detail:

Do You Use A Crate?

Does Your Dog Like The Crate?

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?

Is Anyone In Your Family Afraid Of Your Dog? If So, Please Describe:

Has Your Dog Ever Bitten A Person?

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