New Client Intake Form

Instructions: Please fill out this form as thoroughly as possible. Then use the Print to PDF feature to save your answers and email the completed form.

Client Information

Today’s Date:

Client’s Name: Occupation: Co-Owner’s Name: Occupation: Home/Cell Phone: Email: Address: Children & Ages: How/where did you hear of us?

Have you moved with your dog within the last 12 months? Yes No Have you added or lost any pets within the last 12 months? Yes No Have you added or lost any family members within the last 12 months? Yes No Dog Information

Dog’s Name: Dog’s Age: Breed (or mix): Female Male Fixed Where did you get your dog? How long have you had the dog? Why did you originally adopt your dog(s)? Medical History

List all medications your dog is currently taking: Vet Clinic: Vet’s Name: Vet’s Address: Vet’s Phone: Please list any current or past medical issues including surgeries, infections, etc. Other Pets

Name: Age: Breed: F M Fixed Name: Age: Breed: F M Fixed 1

About Your Dog’s Lifestyle

Where is your dog when he is home alone? Where does your dog sleep at night? Does your dog have a crate? Does your dog like the crate? Yes No Where is the crate located? Does your dog chew or destroy the crate? Yes No How many hours does your dog spend alone each day?

<1 hr 1-3 hrs 3-6 hrs 7-9 hrs 9+ hrs

What kind/brand of food do you feed your dog? How much and how often does your dog eat? Is food left out during the day for your dog to eat? Yes No Dog’s allergies: What kind of toys does your dog have daily access to?

Nylabones Rawhides Stuffed animals Kongs Tennis balls Rope toys Frisbees

Food-dispensing toys Hollow bones Bully sticks Other: How long does your dog play with toys? Where are the toys kept when not in use? How often does your dog go on a walk? Who walks your dog? How long is the walk? Does your dog have any other exercise activities? What does your dog wear on a walk? (Harness, No-Pull Harness, Prong/Chock Collar, Head Halter, etc.?) Do you ever walk your dog off leash? Yes No

Do you take your dog to dog parks? Yes No

Does your dog pull on walks? Yes No

If your dog pulls, what have you tried to change his behavior? 2

About Your Dog’s History

Has your dog ever growled at a person or dog? Yes No If yes, please describe what happened: Has your dog ever nipped/bitten a person or another animal before? Yes No If yes, please describe what happened: If your dog has nipped/bitten a person or animal, was there a tear, scratch, bruise, bleeding, or puncture? (Check all that apply.)

Tear Scratch Bruise Bleeding

Puncture NOT requiring stitches Puncture requiring stitches Is your dog fearful or nervous about certain people/dogs/situations? Yes No If yes, please describe: How does your dog respond to new people in your home? How does your dog respond to grooming or bathing?

What is your reaction when your dog ignores you?

What trainers, boarding facilities, or pet services have you used for your dog in the past? (Name/City) Please list any of the following tools that you currently use or have previously used with your dog:

Martingale Collar Prong Collar Choke Chain E-Collar Bark Collar

Citronella Collar/Spray Spray Water Bottle Clicker Extendible (Flexi) Leash

Waist Leash Front-Attach Harness No-Pull Harness Regular Harness Head Halti

Gentle Leader Others: 3

About Your Dog’s Training Goals

5 Things You Like About Your Dog

1. 2. 3. 4. 5. 5 Things You Wish You Could Change About Your Dog

1. 2. 3. 4. 5. What made you reach out to us for training assistance? What would you like to accomplish through training? How would your ideal dog behave like?

Thank you for taking the time to fill out our registration form. These details will help us better serve you and your dog. We look forward to working with you! 4

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