Private Lessons Intake Form
Handler Information
Owner’s Name
*
First Name
Last Name
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred method of contact
*
Please Select
Text
Phone Call
Email
Best time to contact you
*
Please Select
Weekday Morning
Weekday Afternoon
Weekday Evening
Weekend Morning
Weekend Afternoon
Weekend Evening
Anytime
Will there be other adults or handlers present for training?
*
Yes, another adult
Yes, a minor
Yes, adults and minors
Just me
If you answered yes to the question above please add their name(s) below and relationship to you. If they will not be present and involved in the training sessions no need to list them.
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Dog’s Information
Dog’s Name
*
Breed (please type in Mixed or Unknown if applicable)
*
Dog’s Age?
What is the sex of the Dog and is it fixed?
*
Male - Intact
Female - Intact
Male - Fixed
Female - Fixed
Where did the puppy come from?
*
Breeder
Rescue
Rehomed
Found as stray
How long have you had the Dog or when do you plan to bring the Dog home?
*
Does your Dog have any known medical conditions that may affect training? If so, please explain.
*
Is your Dog up to date on all age-appropriate vaccines?
*
Yes
No but will be adddressed
I will not be vaccinating
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Training Priorities
This section will help me tailor The Puppy Playbook to your specific wants and needs.
What is the reason you are seeking private training sessions?
*
Behavior
Location
Method of teaching
My dog needs tailored training
Other
If other, please explain
What areas are you wanting to work on?
*
Basic obedience
Leash walking
Recall
Manners
Impulsivity
Neutrality
Socialization
Confidence building
Service Dog Foundations
Other
If other please describe
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Home, Routine, and Current Behavior
Who lives in the home?
*
Just me
Other Adults
Children
Cats
Other Dogs
Misc. Animals
Are there children in the home that do not live there that are (or will be) regularly around the Dog
*
Yes
No
In the future
Unsure
If you answered yes to the question above how old and what is the ages of the child(ren)?
Does, or will, the Dog live with or regularly encounter cats, small animals, livestock, or other dogs
*
Yes, cats
Yes, small animals
Yes, livestock
Yes, other dogs
No
Unsure
What motivates your Dog?
*
Food
Toys
Praise
Play
Unsure
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Behavior and Safety Screening
I currently do not work with complex behavioral cases, however I maybe able to refer you to other experts in the area if applicable.
Has the Dog ever growled, snapped, bitten, or attempted to bite a person or animal?
*
Yes
No
Unsure
If you answered yes above, please explain the situation below. Include what happened prior to the incident, the incident itself, and how you handled it.
Has your Dog ever caused an injury that broke skin?
*
Yes
No
Unsure
If you answered yes above, please explain the situation below. Include what happened prior to the incident, the incident itself, and how you handled it.
Does your Dog show intense fear, panic, freezing, lunging, or extreme distress around other people, dogs, handling, noises, or new environments?
*
Yes
No
Unsure
If you answered yes above, please explain the situation below. Include what happened prior to the incident, the incident itself, and how you handled it.
Does your Dog guard food, toys, resting areas, or items they steal?
*
Yes
No
Unsure
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Program fit and booking follow up
How did you hear about Chaos to Confidence Dog training?
Flyer
TikTok
Referal
Facebook
Community Event
Other
Private lessons are customized to your dogs. Individual needs, your household, and your training goals. Each lesson is designed to address the skills, manners, or behavior that you would like to improve upon while providing practical guidance you can continue practicing at home. Completing this form does not guarantee availability.
*
I understand
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