New client form

Your dog's info

Your Dog’s Name

Sex
 Female, spayed Female, intact Male, neutered Male, intact

Breed

Age

How long has s/he been a part of your household?

Where did you get him or her from?
 Breeder Rescue Shelter/Humane Society Pet store Stray Other

How much exercise does your dog get each day, and what form does this take? Please specify weekdays versus weekends.

How does your dog spend his/her days? Is s/he crated, and if so, for how long? Does s/he have free run of the house? Is s/he kept outside?

What food do you feed your dog? What brand? Dry kibble, wet food or a combination of the two?

Is this your first dog?
 Yes No

Please list the people who interact with or care for your dog.

Are there any other animals in the house? Please list name, breed, sex and age.

Problem Behavior

Problem behavior(s), or reason you are seeking an in-home consultation

When did this behavior start?
 Less than a month ago Between a month and and six months ago More than six months ago

Has anything else changed in your dog's life around the time you became aware of this behaviour? Did you move? Did anyone new join the household? Were there any changes in the dog's daily routines?

How frequently does the dog engage in this behaviour?

Have you tried to manage, alter or change this behaviour? If so, what methods have you used? Do you scold him or her? What have you tried?

Is the behaviour getting better or worse? Please explain.

Has your dog ever lunged and snapped at a person?
 Yes No Don't know

Has your dog ever bitten a person?
 Yes No Don't know

If yes to either of the two above questions, please give additional details. What happened just prior to the bite? How badly was the victim injured?

Has your dog ever lunged and snapped at another dog or pet?
 Yes No Don't know

Has your dog ever bitten another dog or pet?
 Yes No Don't know

If yes to either of the two above questions, please give additional details. What happened just prior to the bite? How badly was the victim injured?

If your dog has bitten or threatened to bite, please rate the most severe incident:

Training

Type of training you and your companion animal have participated in (check all that apply)
 In-home private consultations Group classes Puppy classes Puppy play group Agility, Rally or other sport

Have you ever used aversive or correction based training with this animal?
 Yes No Not sure

Are you willing to use positive, reward-based methods to correct this behaviour?
 Yes No Not sure

Medical

Please tell us about any medical conditions you are aware of.

Does your dog have any allergies? Food or environmental?

Does your dog take any medications, pills, supplements or prescriptions? If so, what is s/he taking and how often?

Name of your veterinarian *

Vet’s address or location

Vet’s phone number *

Last visit to the vet (approximately)

Contact Information

Your Name: *

Your Email: *

Phone Number: *

Address:

How should we contact you?
 Email Phone

Best time to contact you:

How did you find out about us?

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