Tell us about you!

Evaluation Form
Tell us about you!
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you or any household members have any physical impairments that may affect your/their ability to participate in the training of your dog(s)?
Tell us about the Canines!

(Please list ALL dogs that live in the home!)
Please list any other animals living in the household:
Let's talk vaccines

*Please note that in the state of Pennsylvania, it is required by law that any dogs or cats at 12 weeks of age must be vaccinated against rabies per Pennsylvania Statutes Title 3 P.S. Agriculture § 455.8. Take a Walk Dog Training will not offer any services until all animals in your household are vaccinated in accordance to this law and have their Canine Distemper (DAPP) and Bordetella vaccinations in date.
Name of your Veterinary Clinic/Hospital:*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
I hereby give Take A Walk Dog Training permission to verify my information with my Veterinarian (initial):*
Now onto the Training Stuff!
YesNo
If yes, please explain:
Anxiety/Fear IssuesLoose-Leash WalkingPotty TrainingResource GuardingBasic ObedienceNew Puppy!Enrichment ProgramVirtual Training
If you selected anxiety/fear issues and/or resource guarding, please explain:
* Please note Take A Walk Dog Training is unable to take aggression cases at this time.
Is there anything else you feel we should know before your phone consultation?
By signing this form, you acknowledge that all information provided by you is true and accurate to the best of your knowledge:*

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You will be contacted via text message or email to arrange the best date and time for your phone consultation, during which we can determine your training appointment date and time, go over the contents of this form, and discuss any other details.

Payment will be due day of your appointment. Checks can be made payable to Take A Walk Dog Training.
Should be Empty:

Evaluation Form

Tell us about you!

Tell us about the Canines!

Let's talk vaccines

Now onto the Training Stuff!