Name
*
First Name
Last Name
Email
*
Address / Location
*
Phone Number
Are you looking for service dog training?
Yes
No
Are you looking for group classes, private training, or other?
Group
Private
Both
AKC Testing Only
I'm not sure
Age
Breed
Sex
Male
Female
Neutered
Yes
No
Where was your dog obtained and how long ago?
Briefly describe your dog's personality:
When was your dog's last vet visit?
MM
DD
YYYY
Was the main issue you're having mentioned to the vet?
Did your dog have previous professional training?
Describe the training classes has had (including the trainer's name or facility if applicable):
Handling: Does your dog react to any negatively?
Check all that apply
Nail Trimming
Bathing
Brushing
Being Lifted
Rolling Over
Patting/Touching Head
Patting/Touching Backside
Patting/Touching Paws
Patting/Touching Underside
Patting/Touching Ears
Hugging or Kissing
Grabbing Collar or Harness
At the Vet
At the Groomer
Handling Notes:
Does your dog exhibit any of the following?
Check any / all that apply.
Jumping on family
Jumping on strangers
Mouthing or nipping
Potties in home
Excessive vocalization
Play biting
Over-excitement or over-arousal
Fear, stress, or anxiety (describe below)
Urinates when excited
Darts from or escapes from doors
Seperation anxiety or uneasy when left alone
Aggressive toward family (describe below)
Aggressive toward strangers (describe below)
Aggressive toward animals (describe below)
Has bit people or another animal (describe below)
Leash biting
Unable to settle
Neurological issues (sudden onset aggression, head pressing, stargazing, etc)
OCD behaviors (light chasing, circling, suckling)
Resource guarding (food, toys, people, locations - describe below)
Pulling on leash - toward distractions
Pulling on leash - always
Multi-animal household issues
Resource guarding
Any other behavioral issues and/or is there anything else you'd like me to know about your dog?
Have you checked out my rates under the "services" tab and are you comfortable with the pricing, INCLUDING the possible upcharge for travel if outside of my service location?
*
If not, please review before submitting.
Yes
No