Private Lesson Questionnaire

PRIVATE LESSON QUESTIONNAIRE
Top Notch Kennels - Modesto, CA

Thank you in advance for providing us with the following information. This will help us prepare so that we can make the best use of valuable time we have together.

Private lesson start date:

private lesson day date start

Client's Full Name

First NameLast Name

E-mail

Phone Number

Format: (000) 000-0000.

Veterinarian's Name:

Veterinarian's Clinic Name:

Referred by:

If you were personally referred to us, who referred you?

List additional family members living in the home (Name, relationship, and if a minor please provide age):

Dog's Name:

Approximate age or DOB:

Breed:

Gender:

Spayed/neutered how long ago?

How or where was your dog obtained?

How long have you had your dog?

How old was your dog when acquired?

Briefly explain your main goal or expectation:

It is our practice to provide you with the least aversive training techniques to help modify your dog's behavior. Some of the methods listed below are not a practice of our training philosophy, however, it is helpful to know what approach has been used in the past.

Which of the following training approaches, if any, have you or your family members tried with this dog? Check all options that apply:

Briefly describe any additional training methods have you used:

What equipment is used to walk your dog? Select all of the following options that apply:

Choose the words that most closely describe your dog’s behavior when MEETING NEW PEOPLE: Check all that apply.

Choose the words that most closely describe your dog’s behavior WITH OTHER DOGS: Check all that apply.

Choose the words that most closely describe your dog’s behavior at HOME WITH THE FAMILY:

Do you feel your dog is:

Does your dog ride in the car?

Choose the behaviors which most closely describes your dog when riding in the car and sees another person?

Choose the behaviors which most closely describes your dog when riding in the car and sees another dog?

Choose which best describes your dog with kids:

Describe how your dog plays with toys and family members. Check all that apply:

Choose all that apply to describe your dog's typical exercise activities:

Frequency of above exercise:

Duration of exercise:

How long is your dog routinely left at home alone during the day?

Where does your dog spend time when left alone?

Where does your dog spend time when family members are at home?

Where does your dog sleep at night? Choose all that apply:

Do you have other dogs or pets in the family? If so, please list species, breed, gender, age:

What is your dog's feeding schedule:

How is your dog's appetite?

Is your dog motivated by food?

Of any food or treat, what is your dog's favorite?

Is your dog sensitive to touch on any part of his/her body? If yes, please explain:

Are there any known medical issues or allergies? If so, please list:

Please list any medication your dog is currently on:

Have you had any previous training with this dog?

If you had previous training was it with Top Notch Dog Training & Kennels?

If you have had previous training, briefly describe:

IMPORTANT INFORMATION – PLEASE READ COMPLETELY

Waiver, Assumption of Risk, and Agreement to Hold Harmless: I understand that participation in dog training is not without risk to myself and my dog as well as any family members or guests who might attend. I hereby waive and release Top Notch Kennels, Inc. Top Notch Dog Training, and all trainers from any and all liability of any nature, for injury or damage suffered as a result of my participation in any class or private lesson, including any damage or injury resulting from the action of any person or dog, or for any accident occurring on the premises or its surroundings. I agree to accept full responsibility for my actions, for the actions of my dog, and the actions of my family or guests.

Cancelations: If you need to cancel your scheduled appointment we ask for a 24 hour notice so we can fill your time slot with another client. Cancelations within 24 hours to your appointment are subject to a $25 fee.

Payment: Payment in full is required at the time of your appointment. There will be a $25 fee for any returned checks.

Thank you again for providing this information. It will help us provide you with the best possible assistance.

By entering my name below and clicking submit, I confirm that I have read and agree to the above.

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