Part I: Owners Information
First Name
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Last Name
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Phone
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Address
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City
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State
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Postal code
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Brand of Dog Food
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Feeding Amount
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How many adults live at home with the dog?
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How many children live at home with the dog? What ages?
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Part II: Dogs Information
Dogs Name
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Dogs Breed
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Dogs Age
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Is your dog neutered or spayed?
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Neutered
Spayed
Other
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Veterinarian Name & Phone Number
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Type of Heart worm Prevention
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Day of Month HW Prevention administered
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Type of Flea/Tick Prevention
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Day of Month F/T Prevention administered
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Is your dog on any other medication? If yes, please detail.
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Dogs Emergency Contact Name
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Dogs Emergency Contact Phone Number
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Do other pets live in the home? If yes, please detail.
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Does your dog interact well with other animals?
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Is your yard fenced?
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Yes
No
I don't have a yard
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Do you have an 'Invisible Fence' system?
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Does your dog tolerate being crated?
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Is there anything you would like me to know about your dog’s present reaction to being crated?
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Mark any of the problems you may be having with your dog
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Not housebroken
Pulls on leash
Separation Anxiety
Does not come when called
Jumps on people
Urinates when excited or afraid
Play bites
Mounts people or objects
Aggressive towards dogs
Aggressive towards people
Guards toys, food, or objects
Guards space
Nuisance barking / whining
Bolts through open doors
Overactive and doesn't settle down easily
Stresses easily
Sniffs or eats off countertops and tables
Jumps on furniture
Digs in yard
Other
Shy Towards:
Growls at Family Members When:
Chews Destructively on:
Anything Else You Would Like to Share About Your Dog?
What are the most important things I can teach your dog to help you enjoy your pet to the fullest?
How did you find/hear about us? Please be specific, i.e. search terms, etc.