| Full Name: | |
| E-Mail Address: | |
| Mailing Address: | |
| Telephone Numbers | |
| Dog's Name | |
| Dog's age and date of birth | |
| Breed of dog | |
| How did you adopt your dog (breeder, shelter,
etc.)? | |
| Date you adopted your dog | |
| Reasons you selected this dog: | |
| Vet name, address and phone number | |
| Any health issues, allergies, etc? | |
| Medications for your dog: | |
| What behavioral or training issues are
you seeking help with? | |
| When did the issues begin? | |
| What do you think is causing the problems
or issues? | |
| What methods have you tried to correct
or train the issues? | |
| What results have you had with the above
methods? | |
| Please list any training education your
dog has had: | |
| What commands/words does your dog know
and respond to? | |
| How many persons are in your household | |
| How many children under 2 live with this dog? | |
| How many children 2-4 years old live with this dog? | |
| How many children 5-12 years old live with this dog? | |
| How many teenagers live with this dog? | |
| Please list any other pets in the household: | |
| How does your dog interact with the other
pets? Who would you say is in charge/dominant among the pets? | |
| What is your dog's diet (schedule
and amounts)? | |
| Who feeds the dog? | |
| Does your dog his/her meal all at once or do you free
feed? | |
| Other notes about feeding (for example,
do you have your dog sit before giving him/her the food?) | |
| Do you give your dog treats? | |
| Is your dog given table scraps/people
food? | |
| What are some of the house rules for your
dog? | |
| Who trains the dog? | |
| How often do you work with your dog on
training? | |
| What training methods have you tried? | |
| How responsive is your dog to the training? | |
| Who disciplines the dog? | |
| How is that done? | |
| Where does your dog sleep? | |
| Is your dog kennel trained? Does s/he use a kennel? | |
| What is your dog's exercise routine? | |
| How many hours of exercise does your dog get per day? | |
| What are your dog's favorite ways
to play? | |
| How many hours per day does your dog spend
alone (typical weekday)? | |
| How does your dog resond to strangers? | |
| How does your dog respond to children? | |
| How does your dog respond to other dogs? | |
| How does your dog respond to other animals
(non-canine)? | |
| How much time can you commit per day to
working with your dog on training issues? | |
| Have you had any recent changes in household
or lifestyle (moved, new pets, new baby, someone moved in or out, etc.)? | |
| Please write any other comments here: | |
| |
