CONSULTATION INTAKE FORM

This form allows the trainers at Kindred Companions to review a history for your pet prior to your scheduled consultation. Please take your time filling out this form and be as careful and detailed as possible.

Owner's Information
Name *
Name
Address *
Address
Phone *
Phone
Pet's Information
Date of Birth *
Date of Birth
Best guess if adopted
Please choose the sex of your dog and their reproductive status.
Pet's History
Medical Information
Date of Last Visit
Date of Last Visit
Date of Last Vaccinations *
Date of Last Vaccinations
Please be as specific as possible
Is your pet easily handled by the vet staff? *
Has he or she ever needed to be muzzled? *
Diet and Housetraining
(if so, please describe)
Is your pet reliably house-trained/litterbox trained? *
Does your pet have access to the outdoors? *
Either a dog door, stays outdoors, etc.
Exercise
Please also include duration of exercise
Has your pet ever become reactive to other pets or people on walks? *
Environment/Lifestyle
Please include Name, Gender, Age, and their relationship to you for each member of the household on a separate line below
Do any of the household members dislike the pet? *
Are any household members afraid of the pet? *
Is the pet afraid of any household member? *
When you are home, is the pet allowed in the house *
If your pet is kept outdoors, would you like him to eventually be indoors?
Do you have other pets living with you? *
Name, type/breed, sex, spay/neuter?
Does your pet get along with the other household animals?
Training
How much training has your pet received?
Dogs Only: If you and your dog attended a training class, did you complete the course?
Please check all the training methods used:
Please let us know how well your pet performs the following behaviors when asked:
Sit
Down
Come
Walk Nicely on a Leash
Leave it
Give
Wait
Go to your place
Quiet
Off (furniture or when they jump)
Please Check the behaviors that apply to your pet
Has your pet ever bitten anyone?
Has medical attention been necessary (for animals or humans) because of any aggressive incident?