Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Sex *

Male

Female

Spayed/Neutered *

Yes

No

Is your dog on any medications? *

Yes

No

Does your dog have any allergies? *

Yes

No

Is this dog currently on Heartworm preventive? *

Yes

No

Is this dog currently on flea/tick preventitve? *

Yes

No

What kind of training has your dog had previously? *

Select all that apply.

Private Training

Group Classes

Board & Train

No Professional Training

Other

Is your dog crate trained? *

This means okay in the crate with the door closed and no one home.

Yes

No

Does your dog potty outside? *

Yes

No

Is your dog crated when you aren't home? *

Yes

No

Is your dog allowed on the furniture? *

Yes

No

With Permission

Does your dog socialize with other dogs? *

Dog park, dog daycare, play dates with friends dogs.

Yes

No

Is your dog scared of loud noises? *

Yes

No

Is your dog sensitive to any parts of his/her body being touched? *

Ears, Mouth, Paws, Nails, backend etc

Yes

No

Is your dog possessive / growled / snapped / bit over food, toys or any other objects? *

Yes

No

Has your dog ever bitten a human? *

Even snapping and nipping if your dog has ever left a bruise or broken skin.

Yes

No

Has your dog ever bitten an animal? *

Yes

No