Name
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First Name
Last Name
Dog's Name
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Dog's Sex
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How long have you had your dog?
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Does your dog have any food allergies or sensitivities?
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Is your dog currently on any psychotropic medications?
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ex: Prozac/fluoxetine, Xanax/alprazolam, Clomicalm/clomipramine, Zoloft/sertraline, Valium/diazepam, Paxil/paroxetine, etc
Please note any major medical conditions or procedures - past or present.
*
ex: patella/hip issues or surgery, bowel obstruction, IVDD issues, broken bones, eye injury, etc
Date of Last Rabies Vaccination
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MM
DD
YYYY
Date of Last Distemper Vaccination
*
MM
DD
YYYY
Date of Last Bordatella Vaccination
*
MM
DD
YYYY
Is the dog currently on heartworm preventative?
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Is the dog currently on flea/tick preventative?
Other members of household
Please include relationship and age of any kids.
Other pets in household
Name / Species / Breed / Approx Age / Spayed or Neutered
What kind of training experience have you and your dog had?
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Check all that apply.
If you have had training - With who? What did you learn? What did you struggle with?
What kind of collar/harness/leash are you using and/or have used in the past?
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Flat collar, martingale collar, harness, head halter, slip leash, pinch/prong collar, e-collar, etc.
Does your dog get car sick?
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Describe any issues surrounding vehicular travel
Is the dog crate trained?
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This means OK in the crate with the door closed and no one is home
Describe any issues surrounding crate training
Do you currently take your dog to dog parks?
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Does your dog socialize with other dogs, outside of a dog park?
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At day care, play dates at your or a friend/family home, etc?
If yes to either of the 2 questions above, what is the frequency and describe how your dog behaves during off leash play and socialization:
Is your dog sensitive to any parts of his/her body being touched?
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Ears, mouth, paws, nails, tail, backend, etc
If yes, describe:
Is your dog ever possessive? Have they ever growled, snapped or bit over food, toys, or other objects?
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If yes, please describe the incident(s). Be as detailed as possible.
Has your dog ever growled, snapped or lunged at someone?
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Human or dog, other than over an object discussed above
If yes, please describe the incident(s). Be as detailed as possible.
Has your dog ever bitten a human?
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Check 'yes' even if snapping or nipping, and even if only left a bruise.
Has your dog ever bitten another dog?
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Check 'yes' for snapping and nipping, and even if your dog didn't leave a puncture or mark.
If yes to either of the 2 questions above, please describe the incident(s) and be as detailed as possible.
Please include details including approximately how long ago, where did it take place, describe the scene prior to the bite, were there punctures, did it draw blood, were sutures needed? If multiple incidents, please list all of them in order.
Is your dog currently muzzle conditioned?
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Does your dog obsessively do any of the following?
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Check as many as apply.
If yes to any, please describe
Are there any OTHER behaviors or challenges you would like to address?
Jumping on people, counter surfing, barking at the doorbell, barking out the window, etc
What are your training goals and expectations?
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Immediate goals and future goals
What are your top 2 training objectives and priorities?
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Is there anything else not covered?
