Puppy Program QUESTionnaire

PUPPY PROGRAM REQUEST & QUESTIONNAIRE
OWNER INFORMATION
Owner's Name*

FirstLast
(Cell Phone)*
Owner's E-mail*
How would you prefer to receive photos/videos?*
How often would you like to receive updates?
How many adults over 18 live in the household?*
How many children live in the household? Please list age(s).
Do you have any other animals in the house? Please list type, sex, age, and breed.
DOG INFORMATION
Dog's Name*
Dog's Date of Birth

MonthDayYear
Dog's Breed*
Dog's Color*
Gender*

MaleFemaleMale - NeuteredFemale - Spayed
TRAINING INFORMATION
Has your dog had any prior training?*

YesNo
If yes, where has your dog done training (or with whom)?
Dog Gone Smart, Petco, Canine Company, etc.
Describe your pup's behavior toward other dogs on leash.
Has your puppy ever played off leash with other dogs before (Other than litter mates)?

YESNOOther
If above answer is yes, please explain your pup's behavior while off leash playing with other dogs and in what settings
Please list all types of Leashes, Collars, Harnesses you currently use with your dog*
Please list your training goals for your pup and prioritize what you would like us to teach them (Please understand that their length of stay will determine how much we can accomplish)*
What commands does your puppy know? Please include "potty" words.
MEDICAL INFORMATION
Does your puppy have any food allergies? If yes, please list ALL FOOD allergies.
Does your puppy have any medical conditions or is on any medications? If so, what is the diagnosis?
BEHAVIORAL INFORMATION
Is your puppy crate trained?
How is your puppy in a crate?*
Anything else we should know about your puppy?
DOG GONE SMART

15 Cross Street, Norwalk, CT 06851

Phone 203-838-7729

Fax 203-838-7763
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PUPPY PROGRAM REQUEST & QUESTIONNAIRE

OWNER INFORMATION

DOG INFORMATION

TRAINING INFORMATION

MEDICAL INFORMATION

BEHAVIORAL INFORMATION