Customer Name: (Required)

Customer E-mail: (Required)

Customer Phone Number:

Customer Address:

City:	State:	Zip:

Any additional directions or parking instructions for your location (Home/Condo/Apartment Number):
Customer Referred By:

Name of dog:

Breed of dog:
(If mixed make your best guess.)

Where did you get your dog?

How old was the dog when you got him/her?

What is the current age of your dog?

Has your dog been neutered or spayed?

Current veterinarian:
How did you find Any Breed Training?

Have you owned a dog before? If so, how many, and what breeds?

If you are not the first owner of your dog, please list any known history of your dog's life with its previous owners.
List other household members/caregivers interacting with your dog.

How do you and your family members/caregivers feel about the dog and interact with the dog?

Training
Please list any type of formal training your dog has received to date.

Has your dog had any treat training?
If "Yes", please explain.

Have you ever used a choke collar or prong collar on your dog?
If "Yes", please explain.

Does your dog display any type of aggression toward you or others?
Include details.

Has your dog ever bitten a human or other animal?
If "Yes", please explain.

Commands
Which of these commands does your dog respond to?
Please give a percentage of response and note any significant problems.

	Inside House	Outside House
Sit:
Stay:
Come:

Does your dog attend doggy daycare or have a dog walker?

In-Home Behavior
List any in-home behavior problems you are concerned about.
Examples: Biting, chewing, bolting, jumping, barking, licking or biting, aggression, child-dog interactions, sharing problems.
Leash Behavior
How does your dog behave on a leash?

Does your dog display any types of aggression toward people or animals while on leash?
If "Yes", please explain.

Off-Leash Behavior
Is your dog allowed off leash? Where and When?

Has your dog had any socialization at off leash dog parks?
If "Yes", please explain.

Has your dog ever run away from you or the house on its own?
If "Yes", please explain.

Dog Health
What type of food is your dog currently eating?
Please list whether dry or canned, etc.

Is your dog receiving any supplements?

Does your dog eat any "human" food?
If "Yes", please explain.
Does your dog have any allergies?

Does your dog have any current health issues?

Has your dog had any past health traumas?