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Call or Text 984-584-2275 (BARK)
melissa@barktobasicstraining.com
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New Client Questionnaire
Home
About Me
Behavior Issues
Puppy Training
Dog Training
Separation Anxiety
Resources
Training Guides
Blog
Videos
Contact Me
New Client Questionnaire
Appointment Form
Appointment Form
"
*
" indicates required fields
How did you hear about me?
*
Client Information
Client Name
*
First
Last
Other Household Members
Name
Age
Add
Remove
Name of Apartment or Condo (if applicable)
Parking Instructions
Address
*
City
*
Zip Code
*
Cell Phone
*
Home Phone
Work Phone
Email
*
Tell us about your dog
Name
*
Age
*
Breed
*
Sex
*
Male
Female
Spayed/neutered
*
Yes
No
Previous Training
*
Yes
No
Describe Previous Training
Is This Your First Dog?
*
Yes
No
Other Pets
*
Yes
No
Age Obtained
*
Place Obtained
*
Veterinarian - Hospital and Doctor's Name
*
Does your dog have any health issues?
*
Yes
No
Describe any health issues?
I send updates to your vet letting him/her know we are working together. Do I have your permission to do so?
*
Yes
No
Where Does Your Dog(s) Stay During the Day?
*
Inside
Outside
Outside but I would like my dog inside
Where Does Your Dog(s) Sleep?
*
What brand of food does your dog eat?
*
How often does your dog eat?
*
What are your dog's favorite things?
*
Petting/Attention
Treats
Toys
Other
Please describe
Additional Dog
Do you have an additional dog?
Yes
No
Name
Age
Breed
Sex
Male
Female
Spayed/neutered
Yes
No
Previous Training
Yes
No
Veterinarian
Does your additional dog have any health issues?
Yes
No
Describe any health issues?
Please indicate those you are experiencing with your dog
Please indicate those you are experiencing with your dog
Chewing
Jumping on people
Digging
Playful biting
Barks excessively
Housebreaking
Pulling on leash
Leash reactivity
Attention seeking
Escapes
Marks territory
Separation anxiety
Fears
Mounting
Shy
Fear of loud noises
Stealing food/objects
Car riding
Trash digging
Chases objects
Grooming/handling
Urinates in fear or excitement
Jumping on furniture
Issues with children
Possessive of food/objects
Counter surfing
Leash shy
Protective
Door dashing
Excessive licking
Tail chasing/obsessive behavior
Aggression
Aggression to people
*
Has your dog ever bitten?
Yes
No
Aggression to people- Describe
Aggression to dogs
*
Has your dog ever bitten?
Yes
No
Aggression to dogs- Describe
Aggression to children
*
Has your dog ever bitten?
Yes
No
Aggression to children- Describe
Aggression to small animals
*
Has your dog ever bitten?
Yes
No
Aggression to small animals- Describe
Basic Obedience
Basic Obedience
Come
Sit
Down
Stay
Name
Walk on Leash
Place
Off
Leave It
Drop It
Select all you would like to work on with your dog
Sociability
Is your dog good with people?
*
Yes
No
Is your dog good with people- Describe
Is your dog good with other dogs?
*
Yes
No
Is your dog good with other dogs - Describe
Has your dog ever bitten a person?
*
Yes
No
Bite(s)/Threat details
Previous bite(s)
Threat/attempted bite(s)
How many times?
If your dog has not bitten but has threatened to bite how many times has this occurred?
Client Priorities/Goals:
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