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?

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

Macho

Hembra

How Long Have You Owned The Dog?

Has Your Dog Been:

Esterilizado

Castrado

Ninguna de las anteriores

Where Did You Acquire Your Dog?

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?

What Commands Currently Work Best?

Which Member Of The Family Has The Best Control?

Does Your Dog Know How To Walk On A Leash?

Sí

No

How Does Your Dog Respond To The Following Tasks?

Trimming Nails?

Giving Pills?

Cleaning Ears?

Grooming

Bathing?

Patting Head?

Being Lifted?

Rolling Over

Tell Me About Any Correction Techniques You Have Used And Their Effect On Your Dog’s Behavior:

Time Out

Leash Correction

Verbal Scolding

Noisemaker

Water Spray

Rollover

Other Description.

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?

Sí

No

Does Your Dog Like The Crate?

Sí

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:

When Approached With Treat Or Toy:

When Dog Is Scolded:

When Dog Is Pushed Off Furniture Or Bed:

When Dog Is Approached While Sleeping:

To Strangers Outside Of The House:

To People Entering House/Yard:

To Children Or Infants:

To Other Dogs In Your Home:

While In Car To People Outside Of The Car:

To Other Dogs Outside Your Home:

Ever Aggrieve To Family Members?

Yes

No

Has Your Dog Ever Bitten A Person?

Sí

No

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

Yes

No