Today's Date*:

Owner First Name*: Last Name*:

Dog's Name*:

Address*:

City*: State*: Zip:

Home Ph.#: Work Ph.#: CellPh.#:

Email*:

Age of dog? Breed Type (if Mix, please list best guess):

Sex: MF Color:

How long have you owned this dog?

Where did you get your dog?
BreederRescue/ShelterPet StoreFriend/RelativeOther

Other than yourself, please list all family members and ages of children. (if applicable)

Is this your first dog? YesNoNo but it has been a while!

Please mark any and all training devices you have tried or are using now:
Prong/Pinch CollarChoke CollarHarnessHead Halti / Gentle leaderFlexi / Retractable leashElectronic CollarClickerTreatsMartingale CollarOther

Has your dog had any other training? If so, what level, where and when? Was it helpful?

Other questions about your dog. Please check any and all that apply.
My dog and I use a dog park.My dog is housebroken.My dog uses a crate.My dog uses an inside potty areaMy dog is tied outsideMy dog has an enclosed yard (above or below ground fencing).

Neutered/Spayed? YesNo If NO, Do you plan to S/N? YesNo

Do you own any other pets? YesNo

If YES, please list all breeds and ages, S/N, etc.?

How often do you walk your dog?

What brand of dog food do you feed?

Please check any behaviors your dog displays:
Jumping on PeoplePulling on the leashAggression toward peopleNot housebrokenExcessive barkingAggression towards DogsDestructive BehaviorFearfulInappropriate MouthingStealing FoodLife of PartyAnxious/NervousPlayfulToo AttachedHappyPushyVocalDemandingWants to be in ChargeShyCRAZY!

Are there any other issues that you are having that are not listed above, please list them here:

Has your dog ever bitten anyone? YesNo Ever snapped at anyone? YesNo

If YES, please explain:

What are your goals/wants/needs for your dog? List as many as you can think of – there is no wrong answer!

Have you looked over our training programs/classes? Are you interested in any in particular?

When is the best time to contact you to discuss your dogs needs?