Owner Name
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First Name
Last Name
Email
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Phone
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(###)
###
####
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Type of Home
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House with a fenced yard
House without a fenced yard
House with invisible fencing
Apartment in a house with access to a fenced yard
Apartment in a house with no yard access
Condo or apartment
Other
is this your first dog as an adult?
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How did you hear about us?
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Dog's Name
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Breed or Mix
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Vaccination History (last 3-5 years)
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Spayed/Neutered?
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Age Spayed/Neutered?
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Date of last flea/tick drug dose
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Put 2000/01/01 if you did not dose your dog with flea/tick drug
MM
DD
YYYY
Does your dog have any physical problems noted by your vet?
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If so, what are the physical issues noted?
Is your dog currently taking medication?
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If so, please list medications
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Do you have other pets in your household?
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If so, please list each pet, their species and any behaviour issues they may have
Please list all people living in the household or who visit frequently, their age and describe their relationship/interactions with your dog
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This information is intended to help us better understand your dog's behaviour
Dog's age when acquired by you
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Where did you acquire your dog?
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How many previous owners has your dog had?
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Have you met your dog's sire and dam (parents)?
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How many littermates does your dog have?
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Describe how the litter was raised/kept
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Are any littermates affected by medical issues?
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If so, what are the medical issues?
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If you chose this puppy/dog, why? If the puppy/dog was chosen for you, why?
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Are you in contact with the owners of your dog's littermates?
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Do you have a fenced yard?
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Provide a detailed description of your dog's exercise routine
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How many training sessions do you and your dog engage in daily?
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How many walks does your dog enjoy per day?
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What is the average duration of a walk?
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How many play sessions does your dog enjoy per day?
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Describe a typical play session
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What does your dog do between these activities?
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Where do you keep your dog when you leave?
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How many hours per day (daytime) does your dog spend in a crate?
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Where does your dog sleep at night?
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List all training equipment currently used
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Type of collar, harness, leash etc.
List all training equipment previously used
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What is your dog's foundation and training history?
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What is your dog's sports training history?
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Proficiency/Success Rate with Training/Activities-LOW DISTRACTIONS/STRESS ENVIRONMENT
Sit
Down
Loose-Lead Walking
Toy Play as Reward
Taking Food as Reward
Proficiency/Success Rate with Training/Activities-MEDIUM DISTRACTION/STRESS ENVIRONMENT
Select Strongly Disagree if your dog does not do well with the activity through to Strongly Agree if your dog does very well with the activity. Leave blank if your dog does not do the activity.
Sit
Down
Loose-Lead Walking
Toy Play as Reward
Taking Food as Reward
Proficiency/Success Rate with Training/Activities-HIGH DISTRACTION/STRESS ENVIRONMENT
Select Strongly Disagree if your dog does not do well with the activity through to Strongly Agree if your dog does very well with the activity. Leave blank if your dog does not do the activity.
Sit
Down
Loose-Lead Walking
Toy Play as Reward
Taking Food as Reward
What tricks/cued behaviour does your dog know?
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Which of these spark excitement and which are calming?
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What is your routine when getting ready to leave the house?
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What does your dog do in response to this?
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Does the dog you contacted us about do any of the following when left alone?
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Check all that apply
You may not know all of these reactions unless you have surveillance of some sort
Do any of your dogs do any of the following when left alone?
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Check all that apply
Does your dog react to any of the following loud noises?
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Check all that apply
In response to loud noises, does your dog do any of the following?
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Check all that apply
How often do loud noises occur?
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Do any other pets have behavioural responses to noises?
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In response to adults or children, does your dog do any of the following?
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Check all that apply
What specifically triggers this response?
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How often does your dog encounter these triggers?
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Do any of your other pets have behavioural responses to children or adult humans?
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Has your dog bitten a human?
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If yes, provide details of the three most recent bites
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In response to adult dogs or puppies, does your dog do any of the following?
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Check all that apply
What specifically triggers this response?
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Please provide a detailed response
How often does your dog encounter these triggers?
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Do any of your other pets have behavioural responses to puppies or adult dogs?
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Has your dog bitten another dog/animal?
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If yes, provide details of the three most recent bites
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In response to a person or dog approaching them when they are engaging with a resource (something of value such as food, a toy, a person, a dog bed etc.), does your dog do any of the following?
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Check all that apply
What specifically triggers this response?
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Please provide a detailed response
How often does your dog encounter these triggers?
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Do any of your other pets have behavioural responses to resources?
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Detail the specific problem you contacted us about
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When did it first occur?
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Did it occur suddenly or slowly over time?
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Has it progressed?
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Is the problem constantly present?
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Additional problem details
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The more info we have, the better
What treatments or methods have been used to address the problem?
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Please provide a detailed answer
I have read and agree to the Liability Waiver and Terms of Service
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