Owner Information

First Name *

Last Name *

Address *

City *

State *

Postal code *

Phone *

Email *

How Many Children Do You Have?

Have You Ever Owned A Dog?

How did you hear about K9Mania?

How did you hear about K9Mania

Google
Facebook
TikTok
Instagram
Website
YouTube
Friend/Referral
Dog Trainer
Others
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Have you Ever Trained A Dog?

Owner's Hobbies: *

Briefly State What You Hope To Accomplish In This Class:

Dog Information

Dog's Name

Dog's Breed

Dog's Age

How Old Was The Dog When You Acquired It?

Gender

Male

Female

How Long Have You Owned The Dog?

Has Your Dog Been:

Spayed

Neutered

None of the Above

Where Did You Acquire Your Dog?

Breeder
Pet Shop
Breed Rescue
Shelter
Other
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Where Does Your Dog Sleep At Night?

Is Your Dog House Trained?

Behavior Problems Of Parents Or Littermates, if Known?

Veterinary Information

Veterinarian

Vet Clinic

Clinic Address

Is Your Dog Current On All Vaccinations including Rabies?

Yes

No

Please upload pictures of the following vaccines:

Rabies Vaccine

Optional

Distemper

Optional

Bordetella/Canine Kennel Cough

Optional

Canine Influenza

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:

Behavior Information

Describe Any Previous Obediance Training:

Level Of Success?

Poor
Fair
Moderate
Excelllent
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What Commands Currently Work Best?

Which Member Of The Family Has The Best Control?

Does Your Dog Know How To Walk On A Leash?

Yes

No

How Does Your Dog Respond To The Following Tasks?

Trimming Nails?

No Reaction
Avoids
Resist
Growl
Snaps
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Giving Pills?

No Reaction
Avoids
Resist
Growl
Snaps
No elements found. Consider changing the search query.
List is empty.

Cleaning Ears?

No Reaction
Avoids
Resist
Growl
Snaps
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List is empty.

Grooming

Grooming

No Reaction
Avoids
Resist
Growl
Snaps
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List is empty.

Bathing?

No Reaction
Avoids
Resist
Growl
Snaps
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List is empty.

Patting Head?

No Reaction
Avoids
Resist
Growl
Snaps
No elements found. Consider changing the search query.
List is empty.

Being Lifted?

No Reaction
Avoids
Resist
Growl
Snaps
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List is empty.

Rolling Over

No Reaction
Avoids
Resist
Growl
Snaps
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Tell Me About Any Correction Techniques You Have Used And Their Effect On Your Dog’s Behavior:

Time Out

Have Not Tried
Worsened Behavior
No Effect
Improved Behavior
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Leash Correction

Have Not Tried
Worsened Behavior
No Effect
Improved Behavior
No elements found. Consider changing the search query.
List is empty.

Verbal Scolding

Have Not Tried
Worsened Behavior
No Effect
Improved Behavior
No elements found. Consider changing the search query.
List is empty.

Noisemaker

Have Not Tried
Worsened Behavior
No Effect
Improved Behavior
No elements found. Consider changing the search query.
List is empty.

Water Spray

Have Not Tried
Worsened Behavior
No Effect
Improved Behavior
No elements found. Consider changing the search query.
List is empty.

Rollover

Have Not Tried
Worsened Behavior
No Effect
Improved Behavior
No elements found. Consider changing the search query.
List is empty.

Other Description.

Behavior Problems

Jumping Up

Chewing

Digging

Barking

Howling

Whining

Urinating

Stool Eating

Tail Biting

Tail Chasing

Staring

Aggression

Describe Unwanted Behavior In Greater Detail:

Describe How Your Dog Reacts To The Following Times When Left Alone:

During The Day:

During The Evening:

What Is Your Dog's Reaction To Your Departure?

What Is Your Dog's Reaction To Your Homecoming?

Do You Use A Crate?

Yes

No

Does Your Dog Like The Crate?

Yes

No

Does Your Dog Exhibit Any Of The Following Behaviors, and When Does It Occurs (With Men Or In The Car)

Cowering

Ears Back

Tail Tucked

Retreating

Hiding

Excessive Salivating

Pacing

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?

Yes

No

Is Anyone In Your Family Afraid Of Your Dog? If So, Please Describe:

How Does Your Dog Respond To The Following Situations?

When Approached While Eating:

No Reaction
Growls
Barks
Snaps
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When Approached With Treat Or Toy:

No Reaction
Growls
Barks
Snaps
No elements found. Consider changing the search query.
List is empty.

When Dog Is Scolded:

No Reaction
Growls
Barks
Snaps
No elements found. Consider changing the search query.
List is empty.

When Dog Is Pushed Off Furniture Or Bed:

No Reaction
Growls
Barks
Snaps
No elements found. Consider changing the search query.
List is empty.

When Dog Is Approached While Sleeping:

No Reaction
Growls
Barks
Snaps
No elements found. Consider changing the search query.
List is empty.

To Strangers Outside Of The House:

No Reaction
Growls
Barks
Snaps
No elements found. Consider changing the search query.
List is empty.

To People Entering House/Yard:

No Reaction
Growls
Barks
Snaps
No elements found. Consider changing the search query.
List is empty.

To Children Or Infants:

Jumping Up
Growls
Barks
Snaps
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To Other Dogs In Your Home:

No Reaction
Growls
Barks
Snaps
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List is empty.

While In Car To People Outside Of The Car:

No Reaction
Growls
Barks
Snaps
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List is empty.

To Other Dogs Outside Your Home:

No Reaction
Growls
Barks
Snaps
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List is empty.

Ever Aggrieve To Family Members?

Yes

No

Has Your Dog Ever Bitten A Person?

Yes

No

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

Yes

No

K9 Mania Dog Training