Sam's Smart Pups Application

Owner Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Describe Your Neighborhood

RuralUrbanBusy (City)SidewalksSchool ZonePark NearbyOther Dogs in the Neighborhood?Other
Phone Number*

Area CodePhone Number
E-mail*
How Did You Hear About Sam's Smart Pups?

Current Smart PupFormer Smart PupSocial Media/WebsiteVeterinarianGroomerFlyers/Business CardsOther
Please Explain The Above Answer (Name of Smart Pup, Name of Vet, etc.)
Briefly State What You Hope To Accomplish With Sam's Smart Pups?*
Dog Information
Dog's Name*
Breed*
Dog's Birthday*
How Old Was Your Dog When You Acquired Him?*
Gender*

MaleFemale
Has Your Dog Been:*

SpayedNeuteredNone of the Above
If No, Please Briefly Explain Why
Where Did You Acquire Your Dog?

BreederPet ShopBreed RescueShelterOther
Please Briefly Explain (Name of breeder, shelter, etc.)
Has Your Dog Ever Had Issues With Strangers Coming To Your House?*

YesNoDon't Know
If Yes, Please Explain The Situation. Please Include How Old Your Dog Was At The Time & What The Stranger Looked Like
Veterinary Information
Veterinarian
Vet Clinic
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is Your Dog Current On All Vaccinations Including Rabies?*

YesNo
If Not, Please Explain Which Vaccine Your Dog Is Missing & Why (Age, etc.)
Vaccination Dates:
Rabies:*
DHLP:*
Please List All Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc
Please List Any Medical Problems Your Dog Has Had, Including Surgeries (Other Than Spay/Neuter):
Please List Any Allergies:
If I Think Your Dog Needs CPR Do I Have Your Permission To Administer It?

YesNo
If I Cannot Reach You In The Case Of An Emergency Do I Have Your Permission To Bring Your Dog To Your Vet?

YesNo
Behavior/Training Information
Describe Any Previous Training:
Level Of Success?

PoorFairModerateExcellent
What Cues (Sit, Down, Stay) Currently Work Best?
Does Your Dog Know How To Walk On A Leash?

YesNoOther
What type of collar/leash/harness do you use?
Tell Me About Any Correction Techniques You Have Used And Their Effect On Your Dog’s Behavior:
Praise And/Or Treats*
Prong Collar*
Shock/Bark Collar*
Rollover/Alpha Rolling*
Other
Other Description, If Needed:
Does Your Dog Have Any of These Behavior Problems:

Jumping UpBarkingAggressionReactive/Aggressive On LeashPulls On Leash
Describe Unwanted Behavior In Greater Detail (if needed):
Describe (to the best of your knowledge) How Your Dog Reacts When Left Alone During The Day:
Do You Use A Crate?*

YesNo
Does Your Dog Like The Crate?

YesNo
If You Don't Use A Crate, Where Is Your Dog When You're Away?
Does Your Dog Exhibit Any Of The Following Behaviors, and When Does It Occurs (With Certain People, In The Car, Etc.)
Cowering
Retreating
Hiding
Excessive Salivating
Please Give Additional Information Regarding Fear Or Anxiety In Your Dog:
Describe Situations Where Your Dog Appears Fearful And/Or Aggressive:
Do You Ever Muzzle Your Dog For Safety?

YesNo
How Does Your Dog Respond To The Following Situations? (Leave Blank If N/A)
When Approached While Eating Or Chewing On Something:*
When Approached While Playing With A Toy:*
When Approached With Treat Or Toy Offered To Him:*
When Dog Is Approached While Sleeping:*
To Strangers Outside Of The House:
To Other Dogs Outside Your Home:
Has Your Dog Ever Bitten A Person?*

YesNo
Has Your Dog Ever Been Reported To Animal Control For Biting?*

YesNo
If Yes, Please Explain The Situation(s)
What Comes Next?

A free evaluation is in your dog's future! An evaluation is a brief Meet & Greet in a public space to decide if your dog and I are a good match. These evaluations are available Friday-Monday and are intended to be as convenient as possible for you! Below, please suggest some dog-friendly parks and places in your neighborhood. (Please try to avoid dog parks where off leash play is allowed, as this could be very distracting!)
Parks And/Or Dog-Friendly Public Spaces Near You
Payments

I accept the following payment methods: Venmo, Google Pay, Circle Pay, Apple Pay, PayPal, Cash, Check
I give permission to Sam's Smart Pups to take pictures of my dog and use for advertising purposes.

YesNo
I understand that cancellations made less than 24 hours before the scheduled appointment will still be charged in full.

I understand that refunds will not be made.

I have read Sam's Smart Pups policies on severe weather and sick days.

I understand that Sam's Smart Pups trains and walks dogs that need help learning good manners. If I come to Sam's Smart Pups with an aggressive dog that needs to be rehabiliated, I will be referred to another trainer.
By Clicking The Submit Button You Agree To The Above Terms
Should be Empty:

What Comes Next?

Payments