Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dog's Date of Birth *

MM

DD

YYYY

This DOB exact

This DOB is an approximation

Date Dog was Obtained *

MM

DD

YYYY

Date of your dog's last vet visit *

MM

DD

YYYY

Places your dog is unable to eat food? *

outside

new environments

on walks

around other dogs

around new people

places your dog is visibly afraid of

around distractions

How often do you walk your dog? *

multiple times a day

Once a day

Couple times per week

couple times per month

How often do you take your dog to the dog park? *

Never

Daily

couple times a week

couple times a month

couple times a year

Where does your dog sleep?

in bed with me

wherever they want

in a crate or pen

in a designated room/area

What equipment do you walk your dog on?

Head halter (gentle leader)

Flat buckle collar

Harness with the leash clipped on the dogs back

Harness with the leash clipped on the dogs chest

prong collar

slip lead or choke chain

Electric collar

martingayle collar

Has your dog done prior training? *

outside of yourself

Yes

no

Has your dog ever nipped, bitten or injured another human? *

any bite history must be fully disclosed

Yes

No

What makes your dog bark? *

check all that apply

the sound of or sight of dogs passing by your home

people entering your home

people passing by when out on a walk

loud noises

for attention

for food

cats, squirrels, small animals

seeing dogs out the car window

seeing people out the car window

I dont know

other

other dogs when out on a walk

none

Check behaviors you would like your dog to learn *

Leave it

Drop: spit that out

No pull walking

heal

crate training

sit when greeting people

lie down

recalls

working on reactivity barking

stay

turn around

other

confidence building

puppy training/management

working through anxiety