Name *
Name
First Name
Last Name
Email Address *
Address *
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone *
Phone
(###)
###
####
Pet's Name *
Breed *
Date of Birth *
Date of Birth
Best guess if adopted
MM
DD
YYYY
Date pet acquired:
Age of pet when acquired:
Pet acquired from: *
Veterinarian's Name *
Date of Last Visit
Date of Last Visit
MM
DD
YYYY
Reason for Last Visit
Date of Last Vaccinations *
Date of Last Vaccinations
MM
DD
YYYY
Vaccination(s) Given *
Current Health Problems/Medications
Past Medications/Treatments
What type of food do you feed your pet? *
What is your pet's feeding schedule? (Times/Amounts) *
What types of treats do you give your pet?
Dogs Only: How often does your dog have access to the outdoors to relieve themselves?
Who is normally responsible for exercising your pet? *
What type of collar or harness and leash is being used? *
If so, Please Describe:
Please list the members of your household
Please include Name, Gender, Age, and their relationship to you for each member of the household on a separate line below
Who will be responsible for practicing the training with your pet? *
Does your pet "belong to" a particular family member or everyone
If so, please write in the reasons:
If so, please write in the reasons:
If so, please write in the reasons:
Where is your pet confined while you are not at home?
If not, please write in your reasons:
Is your pet confined (crated, penned, etc) while you are home? If so, please write in typically how long and your reason: *
Where does your pet typically sleep at night? *
Approximately how many hours a day is your pet without human companionship? *
Never
2-4 Hours
4-6 Hours
6-8 Hours
8-10 Hours
10-12 Hours
12-14 Hours
14-16 Hours
16 Hours or more
Does your pet play with toys, and if so, what are their preferences?
Please List 3 things you like about your pet:
Please list 3 things you do not like about your pet:
If you used a trainer, Please list the organization or trainer's name:
If you checked off "Aggressive", "Fearful" or "Other", please describe below
What proceedures or training equipment have you tried to use to correct these problems?
In order of importance, what would you like help correcting?
If so, please describe in detail below
If yes, please explain below
What is your pet's usual reaction when a person they've never ever met before enters the home?
When was the last time someone unfamiliar to the pet entered your home
Is there anything else that you deem important for us to know?