New Client Form (Dog, 4 months & older) | Canine Advanced Training Services

Owner Name*

First Last

Profession*

Co-owner/ Partner Name*

First Last

Co-owner's/ Partners Profession

Primary Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Cell Phone

Work Phone

Email*

List any chidren (or other occupants) living in the home please list their names and ages*

Dog's Name*

Breed (or mix)*

Current Age*

What age when obtained?*

Color

Sex*

Male
Female

Spayed/Neutered?*

Yes
No

If yes when?*

Heartworm medication (brand)*

Flea/tick medication (brand)*

Has your dog ever had ticks or have you found a tick on your dog? if so when?*

Vet Clinic*

Vet's Name*

Location of Clinic (city)*

Vet Phone*

Any Medical issues past or present? Please list in detail & include medications perviously or currently taken.

Are there any dogs currently living in your home or have lived in the home in the past 18 months? besides the on you listed. Please list name, sex, atered, and breed

What is the reason for yur contacting us?*

What are your intended goals through training/behavior modification?

Why did you get this specific dog?

Where/who did you get this dog from?

What challenges do you face with this dog?

Where does your dog sleep at night?*

Where does your dog hang out when you are not at home?*

How much time does he spend alone during the day?*

Is your dog crate trained?*

Yes
No

Any agression in/ around the crate?*

Yes
No

How does your dog feel about the crate?*

Where is the crate located in your home?*

What specific brand/ type of food do you feed this dog?*

How often do you feed & how much at each meal?*

Is your puppy fed on a schedule ( food is not left out/bowl is picked up after meals) or free-feed ( food is left out/ bowl is not picked up)?*

Schedule
Free-fed

Where is the dog food kept in the house?*

Where are your dog's toys kept?*

How long will your dog play with you- engage with you & not walk away or go of on his own?*

Does your dog dislike certain people or dogs? Who? Explain.*

Does your dog have any fears or sensitivities? If so to what?*

how does your puppy respond to grooming*

How do you respond to your puppy when s/he misbehaves/ doesn't listen?*

List previous trainers/boarding facilities by name/location*

Has your dog ever urinated on you, other family members or non-family members? If so When & Where?*

Has your dog ever growled at you, other family members or non-family members? If so who, when & where?*

Has your dog ever snapped/bitten at you, other family members or non family members? If so who, when & where?*

Does your dog guard food, water, toys, the couch, bed or any other objects?*

Yes
No

Does your dog guard or become protective of you or other family members? If yes please describe what your dog does in this situation with as much detail as possible.*

Does your dog get regular exercise? When? How often? How long? What does it consist of?*

Do you use any of the following tools or techniques? Check an that you've used in the past or are currenly using*

Regarding the above checked items, tell us in what way you felt each techique/tool affected your dog/*

Give us any other details or specifics about your dog that you feel we should know. The more info we know the more we can help you and your dog!

Regarding the above checked items, tell us in what way you felt each techique/tool affected your puppy.*

If you have some aggression issues please tell us about aggressive tendencies, incidents, and details surrounding any of your puppy’s aggressive behavior. Was it directed at a dog (or dogs) and/or person? Where? When? How?*

Would You Like To Receive Emails From us in the Future?*

Yes
No

Comments

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Behavior Questionnaire

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