Client Information for Puppies

Client and Puppy Information

This form must be completed and submitted prior to consult/first appointment.
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

CityState / Province

Postal / Zip Code
Primary Phone*
Secondary Phone*
Email*
Additional Household Members
Name

First NameLast Name
Age
Primary Phone*
Secondary Phone*
Email*
example@example.com
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Pet Information
Puppy's Name
Breed / Mix
Color / Markings
Age
Weight
Gender
Is Your Dog

SpayedNeutered
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?

YesNo
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 ownConfined indoors to a crateConfined indoors to a roomConfined outdoors to a kennel or dog runTethered 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
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Client and Puppy Information