Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner's Age
Select discounts may apply
Owner's Occupation
Select discounts may apply
Preferred Pronouns
Please Select
She/Her
He/Him
They/Them
Other
If other, please state
Preferred method of contact
Please Select
Call
Text
E-mail
Other household members (human)
How did you hear about us?
Please Select
Referred by Friend/Family
Social Media
Referred by Vet/Groomer
I am a previous client
Other
Dog's Name
Dog's breed (if known) or suspected mix
Dog's approximate age or date of birth
Sex
Please Select
Intact Male
Neutered Male
Intact Female
Spayed Female
How long have you owned your dog?
How did you acquire your dog?
Please Select
Adopted from a rescue/shelter
Found as a stray
Friend/Family member
Private rehome from a stranger
Show or sport breeder
To your knowledge, has your dog ever bitten anyone severely enough to need medical attention?
Please Select
Yes
No
If yes, please explain the circumstances that led to the bite
Which service are you interested in pursuing?
Please Select
Harmonious Living
Sport Foundations
Canine Good Citizen or Trick Dog Testing
Pre-Addition Counseling
Courageous Canines
Multiple Services
If selected "Multiple Services", please list which services you are interested in
Are there any other pets in the household?
If yes, please list names, ages, & species/breeds
What skills/tricks does your dog already know?
Have you previously taken any training classes with your dog?
If yes, please list
Does your dog have any health issues the trainer needs to be aware of?
Ie diabetes, torn ligament, blind, deaf, hip or knee issues, etc
Who is your dog's primary care vet clinic?
This is important for verifying vaccination status
Please briefly describe your dog's daily and/or weekly routine
Is your dog currently on any medications or supplements? If yes, please list including dosage & frequency
Are there any food allergies (human or canine) that your trainer needs to be aware of?
Is there is any other important information you feel your trainer needs that has not been covered yet?
Ie disability accommodations needed, house is difficult to find via GPS, etc
Submit
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