NEW CLIENT FORM Client Name First Name Last Name Phone (###) ### #### Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country Spouse Name (or co-owner) First Name Last Name co-owner Phone (###) ### #### co-owner Email Please list any other members living in your household currently (names, ages) First Name Last Name Have you moved with your dog in the last 12 months? Yes No Have you added or lost any pets in the home in the last 12 months? Yes No Have you added or lost any family members in the home in the last 12 months? Yes No Dog General Information Name Breed Age Gender Female Male Spayed/Neutered? Yes No Scheduled Where did you get your dog? How long have you had your dog for? Do you have other pets in your home? Yes No If yes, please list all other pets in home (name, species, breed, age, gender) Medical intake Primary Vet Please list any medications your dog is currently taking Please list any current or past medical issues your dog was treated for including surgeries, injuries, infections, etc. Does your dog have any food sensitivities that I should be aware of? Lifestyle: Confinement Where is your dog when left alone? Where does your dog sleep at night? Does your dog currently have access to a crate? Yes No What is your dogs relationship with a crate? Enjoys crate Tolerates crate Does not tolerate crate Not sure haven’t tried How long is your dog alone each day? Lifestyle: Enrichment How often does your dog walk daily? Who walks your dog? How long are the walks? What does your dog wear for walks? (Flat Collar, Harness, Front Clip harness, Martingale Collar, Prong Collar, etc) Does your dog pull on walks? Yes No Sometimes, but very situationally What have you tried in the past to change this behavior? Do you ever let your dog off leash? Yes No Do you take your dog to dog parks? Has your dog ever been or currently goes to daycare? What other things does your dog do regularly for fun? (Fetch, toys doggies play dates, go for a ride etc) Behavior intake Has your dog ever growled at a person or dog? Yes No If yes, please briefly describe the incident(s) Has your dog ever nipped/bitten a person or animal? Yes No If yes, please briefly describe the incident(s) If your dog has nipped/bitten a person or animal, was there a tear, bruising, bleeding or puncture? Please check all that apply * Broken skin Bruising Bleeding Puncture Puncture needing stitches Is your dog fearful or nervous about certain situations? If yes, please briefly describe How does your respond to new people coming into your home? How does your dog respond to grooming and bathing? Training History Have you ever done formal training with your current or past dog? No, this is my first time! Yes, with my current dog Yes, a previous dog! If yes, what kind of training? (group class, private training, board and train etc) Training Goals What are 3 things you love about your dog? Please list your top 3 goals you want to achieve with your dog through training Is there anything else is should know about you or your dog? Please feel free to add any other information, questions or concerns you would like to address in our training consultation to aid in you and your dogs success through training Thank you!
