First Name *

Last Name *

Street Address *

City *

State *

Postal code *

Email Address *

Cell Phone *

Emergency Point of Contact *

Emergency POC Phone Number *

Dog's Name *

Dog's Breed *

Dog's Age *

Dog's Date of Birth

Please include DOB if known.

Dog's Weight *

Is your dog spayed or neutered? *

Yes

No

What major goals and concerns do you have with your dog? *

Where did you get him/her and how long have you owned him/her? If you adopted your dog, please tell us what you know about their history. *

What motivates your dog and/or your dog's favorite thing to do? *

Has your dog ever been aggressive towards another dog or human? *

Is your dog fearful or shy? *

Tell us how you exercise your dog and how often. *

If you crate your dog, how many hours per day are they crated? *

We kindly request that you inform us if you have any physical disabilities or limitations that may potentially impact the training of your dog. *

Do you have an electric/invisible fence for your dog? *

Yes

No

How did you hear about us? *

How did you hear about us?

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