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Guardian’s Name: *

First

Last

Referred By:

Home Phone:

Cell Phone:

Work Phone:

Address:

Email *

Please enter your email, so we can follow up with you.

Dog’s Name/ID:

Breed/Age/Sex/Neutered/Spayed:

Emergency Contact Name/Phone:

Veterinarian’s Name/Phone:

Dog’s Medication/Medical History/Diet:

In-home Lesson ($90)
Free Parking Available
Will Provide Parking Permit
Paid Parking

1. What do you wish to accomplish with training?

2. For Behavioral Modification: When did you notice the behavioral issues starting? How often does it occur; daily, weekly, monthly?

3. For Training: Please list the skills you would like to teach your dog (attention, sit stay, down stay, come, leave it, drop it, loose leash walking etc)

4. How old was your dog when you first brought him/her home?

5. Describe your dog’s exercise routine (ie. Walks, running, dog parks, daycare)? How often and how long does your dog get exercise?

6. Please described your dog’s socialization experience up to 4 months old. Include any experiences with people, dogs, places, and events that were significant to your puppy.

7. Are there other dogs or pets in the household?

8. Do you use or have you used any of the following devices (circle all that apply) E-Collar/Shock Collar, Prong Collar, Pinch Collar, Head Halter/Gentle Leader, Sensation Harness, Freedom Harness, Easy Walk Harness, Spray Bottle, Bark Collar

9. What do you feed your dog? Include any supplements you use.

10. Check the following descriptions that apply to your dog. My dog is:

CLIENT NAME *

Date