Canine Questionnaire

Please complete the following Questionnaire to help assist us in getting to know your pet. There are no right or wrong answers, as all dogs are unique. Please fill out all information and be as complete & detailed in your responses as possible. We appreciate your time in this important step!

I am interested in: *

Owner's Last Name: *

Owner's First Name: *

Address: *

City: *

State: *

Zip: *

Home Number: *

Cell Number: *

Additional Number:

Email: *

Referred By: *

Dog's Name: *

Breed: *

Birthdate (or approximation): * +

Color: *

Weight *

Sex: *

Spayed/Neutered? *

If Spayed/Neutered, at what age?

Dog's Vet Clinic: *

Where did you get your dog? *

Name of breeder, shelter, rescue, friend, etc: *

When did you get your dog (or approximation) * +

How old was your dog when you brought him/her home? *

If you adopted your pet, what information do you have of your dog's history? *

Why did you pick this particular dog and for what purpose? *

Is this your first dog? *

Is this your first dog of this breed? *

Is your dog on heartworm preventative? *

If yes, what kind?

Is your dog on flea/tick preventative? *

If yes, what kind?

Please list any other medications your dog is on:

Does your dog have an aversion to being bathed or groomed? *

To having nails clipped? *

Please list any physical and/or medical conditions and when they exhibited, including any allergies:

What does your dog's diet consist of?

Dry Dog Food? *

Dry Food Brand/Variety & Amount Per Serving:

Canned Dog Food *

Canned Food Brand/Variety & Amount Per Serving:

Raw Dog Food *

Raw Food Brand/Variety & Amount Per Serving:

Other:

How many times per day do you feed your dog? *

Does your dog finish everything in the bowl as soon as you put the food down? *

Does your dog leave his/her food and return to eat it later? *

What treats does your dog receive and why? *

Does your dog ever hover above their bowl or watch you or any other animals in the household while eating his/her meals, treats, or chew bones? *

If yes, please describe:

Has your dog ever stiffened up, stared, growled, or shown teeth to you or other animals? *

If yes, please describe:

How much time per day (on average) does your dog spend indoors? *

How much time per day (on average) does your dog spend outdoors? *

How much time per day (on average) does your dog spend crated? *

How much time per day (on average) does your dog spend in an area of his/her own? *

Where does your dog stay during the day? *

Where does your dog stay during the overnight? *

Where does your dog stay during the evening when you are home? *

Where does your dog stay when you have guests? *

Where does your dog stay when you travel? *

Does your dog mind being left alone or without your company? *

What activites does your dog enjoy? *

What toys/chewables does your dog enjoy? *

My dog's energy level is: *

What type of exercise does your dog receive and for how long and how often? *

Does your dog roam free in the neighborhood or on your property? *

Does your dog jump over fences? *

Have you ever trained a dog before? *

Who helped you train any previous dogs? *

If you have trained any dog in the competitive arena, what sport and what is the highest level you achieved?

What is your dog's training history? *

What commands/tricks does your dog know? *

Please list every person living in your household, including their age & sex: *

Please list the other animals in your household below. Include name, species, age, sex. Also note if they are spayed or neutered and when that was done. *

Does your dog ever have conflicts with any of the other animals in the household? If yes, please describe: *

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How does your dog react to unfamiliar visitors coming into your home or yard? *

How does your dog react to familiar visitors coming into your home or yard? *

How does your dog react to other people when in public? *

How does your dog react to other dogs when in public? *

Has your dog ever shown behavior towards a person or animal that worries you? Explain: *

Describe your dog's personality: *

Do you believe your dog likes other dogs? *

Does your dog play off leash with other dogs? *

How many other dogs has your dog met since you acquired him/her? *

Is your dog house trained? *

If no, how frequent are accidents?

Does your dog alert you when they need to be let outside to eliminate? *

If yes, how?

Check any that apply to describe your dog: *

Has your dog ever bitten a person or animal? *

What behavioral issues are you experiencing with your dog? *

Have any of these issues increased in frequency or intensity? Explain. *

Have you tried to resolve these issues on your own? If so, how? *

Describe the goals you have for your dog: *

Our next step is to contact your veterinarian to confirm your pet's vaccinations. Checking this box gives us permission to request those records. *

Please contact my veterinarian for my pet's vaccine records.

Training is scheduled based on the eligibility of the dog and the availability of the trainer. Completing this form does not guarantee an appointment or enrollment. Thank you again for filling out this questionnaire - we are looking forward to working with you and your dog soon!