Training Intake Form
Customer Details:
Owner's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Residence?
*
Please Select
House
Townhome
Apartment
Other
Other
Dog's Name
*
First Name
Last Name
*
Breed/Mix
D.O.B. or Age
*
Weight
Color/unique markings
Sex:
*
Male
Female
Intact
Neutered
Spayed
If spayed/neutered, at what age?
*
If spayed/neutered due to a behavioral problem, explain.
*
Fenced Yard?
*
Yes
No
Invisible Fence?
*
Yes
No
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
How did you hear about us?
*
Please Select
Veterinarian
Internet
Former client
Advertisement
Breeder
Rescue/Shelter
Pet-related business
Other
Name of referring individual, organization or publication
*
Where did you obtain your dog?
*
Please Select
Breeder
Individual
Shelter
Rescue Group
Pet Store
Friend/Relative
Found Stray
Other
Other
How long have you had your dog?
*
Were there previous owners? If yes, why was the dog given up?
*
Type of ID?
*
Microchip
Rabies/License Tag
Name Tag
Tattoo
Other
Choose all that apply
Why did you get your dog?
*
Companionship
For the kids
For protection
To breed
Received as gift
Sports/Work
Assistance/Service dog/Therapy dog/ Emotional Support dog
Companion for other dog
Other
Choose all that apply
Have you owned other dogs in the past? If yes, what breed?
*
List any physical/breed characteristics that contributed to your choice for your current dog:
*
Suggestions if any for further improvement:
Veterinarian
*
Name
City
Date of last visit
*
Month/Year
Reason
Back
Next
Vaccinations
*
Date of last vaccination
Vaccine(s) given
Current health problems/Medications:
*
Past medical conditions/Treatment:
*
Does your dog have any allergies, including food allergies:
*
Is your dog easily handled by the vet staff?
*
Yes
No
Has he/she ever had to be muzzled?
*
Yes
No
Is your dog on heartworm preventative?
*
Yes
No
Is your dog on flea and/or tick preventative?
*
Yes
No
Brand of Heartworm medication:
*
Brand of Flea and/or Tick medication:
*
May we contact and discuss health and behavioral issues with your veterinarian?
*
Yes
No
Please list three of your dog's favorite treats:
*
Has your dog ever become possessive of his food or a treat? If so, please describe in as much detail as possible:
*
Is your dog reliably housetrained?
*
Yes
Mostly (infrequent accidents)
No
Is your dog crate trained?
*
Yes
No
What type of exercise does your dog get? If not receiving any exercise at this time, note "none" and the reason:
*
How long does the exercise last/how often is it provided?
*
Who is normally responsible for exercising your dog?
*
If walks are provided, what type of collar and leash is being used?
*
Does your dog ever become reactive toward other dogs or people? If so, please describe:
*
List all people, including yourself, who live in your household:
*
Rows
Name
Gender
Age (of children)
Relationship to you
1
2
3
4
5
Who will be responsible for practicing training exercises with the dog?
*
Does your dog "belong to" a particular household member (e.g., son) or everyone?
*
Do any household members dislike the dog, and if so, why?
*
Are any household members frightened of the dog, and if so, why?
*
Is the dog frightened of any household members, and if so, why?
*
Where is the dog kept when you are not at home?
*
Indoors not confined
Indoors confined
In yard not confined
In yard confined to dog run
In yard tied up or chained
Other
Choose all that apply
When you are at home, is your dog allowed in the house?
*
Yes
No
If you dog is not allowed indoors at all, why not?
*
Allergies
Cleanliness
Not potty trained
We prefer it
Destructive
Outside working dog
Other
Choose all that apply
If you dog is an outdoor dog, would you like hime to eventually be able to be indoors?
*
Yes
No
If indoors, is your dog ever confined (crated, penned) while you are home? If so, how? How long is your dog confined on an average day and why?
*
Where does your dog sleep at night?
*
How many hours per day is your pet without human companionship?
*
Do you have other pets?
*
Yes
No
List all the other pets in the household:
*
Rows
Kind
Breed
Age
Sex
Neutered/Spayed
1
2
3
4
5
Three things I like about my dog:
Three things I do not like about my dog:
If your other pet is a dog or cat, how does your dog get along with the other pet?:
Submit
Should be Empty: