Name
*
Email
*
Phone
*
Address
*
City
*
State
*
Zip
*
Referred by
*
Best time to reach you to discuss issues
*
Dog Name
*
Age
*
Weight
*
Breed
*
Color
*
Emergency Contact
*
Emergency Phone
*
Vet Information
Spay or Neutured?
*
yes
no
Was your dog adopted?
*
yes
no
If so, from where?
Adoption date
Type of home (apartment, condo, house)?
*
Medical Problems
*
Growls near food?
*
yes
no
Sleep/Rest Location
*
Crate Trained?
*
yes
no
Allows Grooming?
*
yes
no
Types of toys
*
Types of games you play with your dog
*
Previous Training?
*
yes
no
Commands
Pulls On Leash?
*
yes
no
Is your dog ever off leash?
*
yes
no
Leash Aggressive?
*
yes
no
Aggressive towards other dogs?
*
yes
no
Aggressive towards people?
*
yes
no
Is your dog hyper?
*
yes
no
Is your dog a barker?
*
yes
no
Does your dog growl?
*
yes
no
If so, describe the occasion/frequency
Does your dog allow to be picked up?
*
yes
no
Is your dog an escape artist?
*
yes
No
Does your dog know when you are upset at his/her behavior?
*
yes
no
Does your dog show signs of submission?
*
yes
no
Detail of issues and when they began
*
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