Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact number
Email
example@example.com
Veterinarian Address and Contact Number
Other family members and pets in the home
Regular visitors to the home:
Dog Details
Information about your dog
Dog's Name
Dog breed or mix
Date of Birth
/
Month
/
Day
Year
Date
Do you know anything about your dogs' parents or siblings? e.g. temperament, health issues etc.
Age at time of adoption
Where did you adopt your dog from? e.g. breeder, shelter (please specify details)
Health
Date of Last Vet Visit
/
Day
/
Month
Year
Date
Did your dog get a clean bill of health? If no, please specify
Is your dog spayed/neutered?
Yes, Spayed
Yes, Neutered
No
Date of SpayNeuter
/
Day
/
Month
Year
Date
Most Recent Weight
Does your dog have any ongoing health concerns?
Does your dog have any allergies?
Regular medications or supplements:
Diet
How many meals does your dog have per day
Type of food e.g. kibble, raw, mixture (please specify)
Have there been any recent Changes to diet
Do you give your dog food treats? e.g. for training
Do you give your dog any human food? e.g. scraps etc
Does your dog eat very quickly, or at a normal pace?
Has your dog shown protectiveness over their food?
Exercise
Including on and off-lead walks
How much weekly exercise does your dog get?
Where is the dog walked/exercised?
Do you enjoy walks
Does your dog run free, regularly? If YES, please describe
Does the dog take part in any other exercise activities If YES please describe
Does your dog like to be groomed
Training and Behaviour
This area is veryimportant, because it tells us about your dog’s prior learning experiences. Itis vital that your responses are honest and provides as much detail aspossible, as it will help us to better understand your dog as we move forward.
Has your dog ever had training? If YES, please specify e.g. puppy classes etc
How much time do you currently spend on training, each week?
Type of training e.g. positive, corrections etc
What has your dog learned so far?
Have you ever used a professional trainer before? If YES please give details of what training was given.
Please describe your top 3 behaviour challenges
On a scale of 1-10 (10 being the most severe you can imagine) please rate the severity of your top 3 challenges. Specify each behaviour problem, then a rating
How frequently does each behaviour happen?
How quickly does your dog recover after an episode e.g immediatly, after a few minutes, can take hours?
When did the behaviour first start?
What does the behaviour look like?
Was there a particular incident that triggered it?
Have you tried anything else to solve the problems so far?
Have you ever considered rehoming your dog?
There is no judgment here. This helps me understand how you are currently feeling about the situation.
Home Environment
Where does your dog sleep?
Does your dog sleep during the day If so where?
Have there been any changes in the home environment, in the past 3 months?
Past 6 Months?
Past 12 months?
Is your dog generally relaxed in the home?
How does your dog react to visitors coming in to the house?
Does your dog settle, when left alone? If NO, please explain
Is your dog destructive when left alone Eg chews inappropriate things
Outside the home
How does your dog, generally, react to the following, when outside...
Other people, including children?
Vehicles, bikes, buses etc?
Other dogs?
Bite History
Has your dog ever bitten another dog? .
If YES, please give as much detail as possible including severity and whether medical attention was necessary
Has your dog ever bitten another human?
if YES, please give as much detail as possible including severity and whether medical attention was necessary
Additional Information:
Do you give consent for me to request your dog's medical records, if needed?
Yes
No
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Confirmation
I confirm that the information I have given, regarding my dog, is true and accurate and that I will hold Pawsitive Pups Dog Training, or its' representatives, in no way liable for any incidents arising from information I have deliberately, or knowingly withheld about the behaviour of my dog.
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Date & Time
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