Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Email *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePreferred Method of Contact *PhoneTextEmailEmergency Contact *Dog's Name *Breed(s) *Age *Sex *MaleFemaleSpayed / Neutered *YesNoWeight *Where did your dog come from? *BreederRescue / ShelterRehomedOtherIf Other, DescribeHousehold Information - Who lives in the home? *AdultsTeenagersChildren Under 12SeniorsAre there other pets in the home? *YesNoIf yes, list pet info dog listed you Describe your dog's daily environment *HouseApartmentCondoFarm / Rural PropertyDoes your dog have access to a fenced yard? *YesNoVeterinarian Name *Veterinarian PhoneIs your dog current on vaccinations? *YesNoNot sure, I will check before trainingExplain any known medical conditions or allergies (bees, food, etc)otherwise write NONE *List any medications being takenDescribe if your dog has had any Pain, Injury or Mobility issues, otherwise write NONEHas your dog had previous training? *YesNoNot sureHave you worked with a trainer before? *YesNoDescribe any prior training, including methods used with a trainer.Current Behaviors & Concerns (check all that apply) *Pulling on LeashJumping on PeopleExcessive BarkingReactivity towards dogsReactivity towards peopleSeparation AnxietyHouse Training IssuesDestructive ChewingResource GuardingFearfulnessAggression towards dogsAggression towards peopleNot coming when calledCounter SurfingDoor RushingMouthing / NippingOtherIf Other, describe hereFor each concern, please describe: ● When it occurs ● How often it occurs ● What triggers it ● What happens afterwardWhat are your top 3 goals for training? *What would success look like for you and your dog? *How much exercise does your dog receive daily? Less than 30 minutes30-60 minutes1-2 hoursmore than 2 hoursWhat type of exercise? *WalksRunningFetchDaycareDog ParkOtherHow many hours is your dog left alone each day? *Rewards & Motivation - what does your dog enjoy? *Food treatsToysTugFetchPraisePettingOtherDescribe any specific food treats your dog loves, or any other reward not listed above. Safety & Bite History Has your dog ever *Bitten a personAttempted to bite a personBitten another dogFought with another dogNone of the aboveProvide more details if applicableHow much time can you realistically commit to practice each day? *5-10 minutes10-20 minutes20-30 minutesmore than 30 minutesWhat factores might affect consistency?Is there anything else you would like me to know about your or your dog?SubmitSave and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link
