Client's Name *
Client Email *
Client Phone *
Alternate Contact Name
Alternate Contact Phone
Dog's Name *
Breed / Mix *
Date of Birth / Age *
Who referred you?
If you found us through a method not listed above, please enter it here.
If spayed/neutered, at what age? *
How long have you had your dog? *
Age of dog when adopted/purchased?
How long has this dog been in your care?
Where did you obtain your dog? (other) *
Name of breeder/shelter.
Did the shelter have any information about the dog's life previous to your adoption?
Does your dog have any particular way they like to be petted? *
Veterinarian's Name *
Month / Year of last vet visit *
Month / Year of last vaccination *
Vaccine(s) given *
Current health problems and/or medications
Does your dog have any allergies, including food allergies?
Heartworm Preventative Brand *
Heartworm Preventative Last Received *
Flea/Tick Preventative Brand *
Flea/Tick Preventative Last Received *
If yes, please initial here: *
What type of food do you feed? (e.g., raw, dry kibble, canned) *
How often? *
How much? *
At approximately what times? *
Approximately how long has your dog been on this food? *
If not, how long is the food left down? *
If this is unusual, how long has it been going on? *
Frequency and type of snacks. *
Please list 3 of your dog’s favorite foods/treats: *
If yes, please describe in as much detail as possible:
If Paper/Pad trained, where in the home do you usually place the pads ? *
If not, how many times daily do you let your dog out (or take them on walks) to eliminate when you are at home? *
Average Walk Time *
Average elimination time *
Average number of eliminations per walk *
What type of exercise does your dog get? *
How long does the exercise last/how often is it provided? (For example, “a 15-minute walk three times daily,” or “plays with the neighbor's dog for an hour once a week.”) *
What kind of toys does your dog enjoy playing with/Do they have a favorite? *
Does your dog have any favorite games they like to play? *
Who is normally responsible for exercising your dog? *
If walks are provided, what type of collar and leash is being used? (Collar examples: “regular buckle collar,” “head halter,” “body harness,” “pinch/prong collar,” “choke chain.” Leash examples: “6-foot nylon leash,” “retractable leash.”) *
Does your dog get easily distracted or pull you on walks? *
If yes, please describe: *
List all people, including yourself, who live in your household: (Name, Gender, Age (of children), Relationship to you) *
Does your dog “belong to” a particular household member (e.g., son) or everyone? *
Who will be responsible for practicing training exercises with the dog? *
Do any household members dislike the dog, and if so, why? *
Are any household members frightened of the dog, and if so, why? *
Is the dog frightened of any household members, and if so, why? *
Where is your dog kept when you are not at home? * Indoors not confined In yard not confined In yard tied out or chained Indoors confined In yard confined to dog run Other
If you selected "other", please describe here: *
If so, how long is your dog confined during the day? *
If you selected "other", please where your dog sleeps. *
How many hours during the day is your pet without human companionship? *
Three things I like about my dog: *
Three things I do not like about my dog: *
Please describe the type/ age/ sex of your other pets and whether they have been fixed or not.
List organization name and/or trainer’s name(s): *
Sit *
Down *
Stay *
Walk nicely on leash *
Leave it *
Give *
Wait *
Go to your place *
Quiet *
Off (furniture or when jumps up) *
Others behaviors (including tricks):
Notes / additional descriptions from the above behavior list:
List any procedures/training equipment you’ve used to try to correct the behaviors checked above:
What would you like help with, in order of importance? *
If your dog has bitten anyone or another animal, please describe in as much detail as possible: *
If medical attention has been necessary, please explain: *
What is your dog’s usual reaction when a person they have not met before enters the home? *
When was the last time a person unfamiliar to your dog entered the home? *
Is there anything else you feel it would be important for us to know?
