Client Information for Puppies

I greatly appreciate you taking the time to complete this questionnaire. This information will be used solely to review your dog’s history and to help me prepare a plan for training or behavior modification.

Please review this entire questionnaire first, then go back and answer the questions as thoroughly as possible. If there was an incident (such as a bite), please ask anyone who witnessed the bite incident for their input as well.

The information contained herein will only be shared with another trainer, veterinarian, veterinary specialist or veterinary behaviorist with your permission.

Client Name *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone *

Cell Phone *

Email *

Additional Household Members

Name

First Name Last Name

Age

Contact Info:

Name

First Name Last Name

Age

Contact Info:

Name

First Name Last Name

Age

Name

First Name Last Name

Age

Name

First Name Last Name

Age

Pet Information

Puppy's Name

Breed / Mix

Color / Markings

Age

Weight

Gender

Is Your Dog

Spayed Neutered

Other Pets in Your Home: Please provide same information about each as above.

Tell Me About Your Puppy(ies)

Why did you decide to get your puppy(ies)?

Have you owned other dogs? If so, what type and when?

Where did you acquire your puppy(ies) from?

If adopted from a shelter or rescue group, please provide the name of the organization and a point of contact

When did you acquire your puppy(ies)?

Medical Information:

Name, Address and Phone number of your veterinary service:

Current health issues and medications:

Past medical conditions and treatments:

General Information

Do You Have a Doggy Door?

Yes No

What type of exercise does will your puppy(ies) get and how often?

What type of home do you live in?

Does your home have a fenced in yard? if so, what areas of your yard are fenced and what type of fence?

When no one is home, will your puppy(ies):

Able to go in and out on it's own Confined indoors to a crate Confined indoors to a room Confined outdoors to a kennel or dog run Tethered outdoors

If your puppy(ies) is confined when you're not at home, how long is your puppy confined for?

If your puppy(ies) is confined when you're not at home, why is your puppy confined?

Where does your puppy(ies) sleep at night?

Does your puppy(ies) get along with your other pets? If not, please specify any conflicts

What are your puppy's favorite toys and games?

List five things you like about your puppy(ies)

List 5 things your puppy(ies) looks forward to every day (not including being fed)

List 5 things you'd like to change about your puppy(ies)

Help for Your Puppy(ies)

List in order of importance the things you'd like help with

Tell me anything else you feel it is important for me to know about your puppy(ies);

By selecting the “I agree” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. I further agree that my signature on this document is as valid as if I signed the document in writing.

Please visit my website to learn more about my training, education, methods, skills, credentials and history

www.theinnerdog.com

Client and Puppy Information