Behavior Questionnaire

Full Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Do you receive texts to this number?

Yes No

E-mail

What is the best way to contact you?

Phone call Email Text Facebook Messenger

Physical Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How did you hear about me? *

Puppy's Name *

Breed or mix *

Where did you get your puppy? Please include NAME of rescue, shelter or breeder if applicable. *

Puppy's age now or date of birth, if known: *

How old was your puppy when you got him/her? *

Is your puppy spayed or neutered? *

Yes No Not Yet

Puppy's sex: *

Male Female

Puppy's weight *

Coat color *

Do you use a crate with this puppy? *

Yes No We have one but do not use it. We use an ex-pen We confine the puppy to a room (with or without baby gates)

Has your puppy ever seriously bitten a person or other animal? *

Yes No

If yes, please explain:

Is your puppy motivated by food/treats? *

Yes Sometimes/Depends on the food/treat No

Is your puppy motivated by toys? *

Yes Sometimes/Depends on the toy No

How often is your puppy exercised? *

What kinds of exercise does your puppy get? *

List any medications your puppy is currently on:

Does your puppy have allergies?

What brand/s of dog food do you feed your puppy? *

How many times a day is your puppy fed? *

Veterinarian (Vet's name & clinic name): *

Has your puppy had previous training? If yes, please list where and name of trainer: *

List any skills your puppy has (sit, down, stay, etc) *

What are your goals/why are you interested in training? *

If you are having problems beyond typical puppy behaviors, explain your issue/s:

How long have you been dealing with the issue/s?

What/how have you tried to fix the issues?

Please list any other pets in the home (name, breed, age):

Who lives in the home fulltime? Include ages of children, if applicable. *

How much time does your puppy spend home alone? *

Where does your puppy stay when home alone? *

Where does your puppy sleep at night? *

Is there anything else you would like me to know about you or your puppy?

What days/time frames would be best for you to schedule a consult? *

I am interested in: *

Puppy Survival Program (3 lessons) $350 Puppy Manners Program (5 lessons) $500 Puppy Prodigy Program (8 lessons) $750 Ultimate Puppy (25 lessons) $2300

I understand that dog training and behavior modification is not without risk to myself, members of my family, guests, or my dog or other pets. I hereby waive my rights to any claim and release Jessica Hudson from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not limited to, any injury or damage resulting from the action of any dog, and I expressly assume the risk of any such damage or injury while attending any training session, function or event wherever the activity is taking place. In consideration of and as inducement towards the acceptance of my enrollment in lessons, I hereby agree to indemnify and hold Jessica Hudson from any and all claims, or claims by me, any member of my family or any other person accompanying me to any training session wherever they may be located arising out of any action by any dog, including my own, including but not limited to the responsibility for all damages, expenses and legal fees. I further indemnify and agree to hold harmless Jessica Hudson from any and all claims, or claims by any third party at any training session wherever they may be located arising out of any action by any dog, including my own, including but not limited to the responsibility for damages, expenses and legal fees.

Session and consultation fees are due in full at the end of each training session unless otherwise agreed upon by both parties. Client will be billed at the normal appointment fee for any “no shows” or appointments cancelled with fewer than 24 hours notice. Cancelled package sessions with less than 24 hour notice will be forfeited. Any returned checks are subject to a $30 bank fee and a $20 late fee. Cash and personal checks are accepted, PayPal accepted for behavior consult deposits. All package/program sessions must be used within 3 months of initial consult.

Cancellations received 72 hours prior to scheduled appointment will be accepted without penalty.
Cancellations received less than 72 hours prior to scheduled appointment will be subject to a $35 rescheduling fee.
Cancellations received less than 24 hours prior to scheduled appointment will result in the forfeiture of that session, with no refund.
Cancellations due to inclement weather are not subject to penalty.

I have read and, by completing this form and clicking submit below, agree to abide by the aforementioned Waiver and Assumption of Risk and Agreement to Hold Harmless.

Puppy Programs Form

Puppy 1

Additional Information