Appointment Form Appointment Form "*" indicates required fields How did you hear about me?* Client InformationClient Name* First Last Other Household MembersNameAge Add RemoveName of Apartment or Condo (if applicable) Parking Instructions Address* City* Zip Code* Cell Phone*Home PhoneWork PhoneEmail* Tell us about your dog Name* Age* Breed* Sex* Male Female Spayed/neutered* Yes No Previous Training* Yes No Describe Previous Training Other Pets* Yes No Age Obtained* Place Obtained* Veterinarian* 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 DogDo 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 dogs*Has your dog ever bitten? Yes No Aggression to children*Has your dog ever bitten? Yes No Aggression to small animals*Has your dog ever bitten? Yes No Aggression to people- Describe Aggression to dogs- Describe Aggression to children- Describe Aggression to small animals- Describe Basic ObedienceBasic 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 dogSociabilityPrevious bite(s)Threat/attempted bite(s)Is your dog good with people?* Yes No Is your dog good with other dogs?* Yes No Has your dog ever bitten a person?* Yes No Is your dog good with people- Describe Is your dog good with other dogs - Describe How many times? If your dog has not bitten but has threatened to bite how many times has this occurred?Client Priorities/Goals:CAPTCHA
