Helping families, one dog at a time
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your Dogs Name:
*
Owner 1
*
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
example@example.com
Owner 2: (significant other or shared adult)
First Name
Last Name
Email:
example@example.com
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Physical Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dog's Approximate Age:
Breed:
Physical Description (color/weight):
Sex of Dog:
Spay or Neutered (Y/N)?
1. Where did you get your dog? Rescue/Breeder, etc?
2. How long have you had your dog?
3. Dogs Approximate age when it came to you:
4. Is your dog vaccinated for Rabies, Bordetella (Kennel Cough), or Leptospirosis?
5. What are your goals for training your dog?
6. Check Problem Behaviors:
Aggressive
Animal Reactive (explain in comments)
Anxious/Anxiety
Barks
Bites
Bolts
Cars, Afraid Riding in Car
Cats, Good or Very Good
Cats, Tolerable
Cats, Negative
Cats, Wants to Play
Chases Cars/Biles/Wild Life, etc.
Chews
Defiant
Digs
Dog Reactive
Fear of Lound Noises/Thunder/Cars, Etc.
Fence Climber/Fighter
Fights
Food Aggressive
Growls/Shows Teeth
Howls
Human Aggressive
Jumps Up
Lacks Leash Manners
Lunges
Needy
Overprotective
Poor Recall
Resource Guarding
Runs Away
Self Mutiliates
Separation Anxiety
Shy
Soils/Urinates in House
Stairs - Not Good With
Stairs - Afraid Of
Stubborn
Table/Counter Surfer
Toyr Aggression
7. Any Problem Behaviors Not Listed?
8. Is this the first dog you have owned as an adult?
9. How many people does your dog live with? Adults/Children 10 and under:
10. How does your dog get along with all the people in the household?
11. If you have other pets, what kind, age and how many?
12. If you have cats, tell us HOW your dog gets along with them?
13. How does your dog get along with other pets in your home? Any issues?
14. Has your dog ever shown aggression, growled, snapped or bitten you or anyone else? What happened?
15. Has your dog ever shown aggression toward other dogs or pets that ARE NOT yours? What happened?
16. Does your dog get nervous around strangers? If so, please explain:
17. How many minutes/hours a day is your dog typically alone?
18. How many minutes/hours a day does your dog get exercised? Please explain how you exercise your dog.
19. How many leash walks does your dog get a week?
20. Is your dog allowed off leash and if so where?
21. Do you tend to spoil your dog?
22. Is your dog like "a child" to you?
23. Do you think your dog has gotten mad at you and if so, what did it do?
24. If your dog gets upset when you leave it alone, what does it do?
25. How do you tend to discipline your dog and does it work?
26. Do you confine your dog (another room, crate, yard, etc) away from you?
27. Does your dog live in the house? And if not, where do they live and why?
28. Is your dog crate trained?
29. Is your dog potty trained?
30. Have you punished your dog for soiling in the house?
31. Do you have to repeat commands to get your dog to respond?
32. Does your dog come back when called?
33. Has your dog been through other training programs?
34. If so, do you feel you have been consistent in keeping up and following through with that training?
35. Is your dog allowed on the furniture?
36. Does your dog sleep in your bed?
37. Do you have a fenced-in yard?
38. How is your dog in the car?
39. How did you hear about us? If it is by someone we know, we would like to say "THANK YOU!"
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