Training Behavior Questionnaire

Dog Training and Behavior Questionnaire
Today's Date

MonthDayYear
Date
OWNER INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
DOG INFORMATION
Dog's Name*
Age*
Breed
When did you acquire them?
Gender

MaleFemale
Where did you get your dog from? Include name of organization if known.
Reason for contacting us.*
New puppy, new dog, general training, problem behavior, other, etc.
BEHAVIOR PROBLEMS
Are you seeking help for Behavior Problems?*

YesNo
Check all that apply and are a concern to you and give details.

AnxietyAggression - PeopleAggression - DogsAggression - Other animalsBarking, vocalizing excessivelyChasing moving objects (bike, vehicle, etc.)Chasing people or dogsCounter SurfingDemanding, attention seekingDestructive (chewing, scratching, etc.)DiggingDoor dashingEscaping (Fence jumping, etc.)FearHouse soilingJumping upRunning offSeparation AnxietyStealing food, objectsUnruly (Jumping, mouthing, etc.)Leash PullingSubmissive UrinationOther
Please describe the behavior problems you're experiencing with your dog (and any other animals in your home).
Please tell us about your dog's exercise routine. (walks, running, dog daycare, etc.)
How does your dog walk on a leash, and what walking equipment do you use?
Is there a history of aggression/hostility? Has any dog in the home ever bitten someone? Please note, answering "yes" does not preclude you from our services. Please be honest and detailed if the answer is "yes" so we can accommodate your dog's needs.*
HEALTH AND VETERINARY INFORMATION
Current Veterinarian*
If no, please advise.
Are your animals up to date on vaccinations (Rabies, Distemper, Parvo, Etc)?*
Please list and describe any past or present medical health issues.
Does your dog have any allergies/food sensitivities/gastrointestinal issues?
HOUSEHOLD
What type of home do you live in?

HouseCondoApartmentOther
How many people live in your home?
Are there children in your home? If so, how many and what age(s) are they?
Are there any members of the household that have health condition(s) which could impact training?
What animals live in your home? Please describe each: Name, Gender, Breed, Age, Temperament, Health Concerns, Spayed/Neutered/Intact.
Do you have a fenced-in yard? If so, please describe.
Is there any pertinent information you have to share related to your home, environment, neighborhood, etc?
DIET AND FEEDING
What do you feed your dog? Please be specific (Brand, variety, canned, dried, raw, homecooked, etc.)
Is there anything else that you would like us to know about your situation or your dog?
How did you hear about our training services?

Word of MouthSearch EngineFriends/FamilySocial MediaOther
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.*

Yes
PLEASE CONTACT OUR TRAINING TEAM IN 2-3 DAYS TO FOLLOW-UP ON YOUR QUESTIONAIRE IF YOU HAVENT HEARD FROM US!

Phone: (609) 231-4173
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Dog Training and Behavior Questionnaire

OWNER INFORMATION

DOG INFORMATION

BEHAVIOR PROBLEMS

HEALTH AND VETERINARY INFORMATION

HOUSEHOLD

DIET AND FEEDING