Client Information Form - For the Love of Dog Training

Client Information

Date

Owner's Name *

Dog's Name *

Address

Breed/Mix

D.O.B. or Age

Weight

Color/Unique Markings

City

State

Zip

Home Phone

Work Phone

Cell Phone

Email *

Occupation

Sex

Male Female

Spay/Neuter Status

Intact Neutered/Spayed

If spayed/neutered, at what age?

How did you hear about us?

Name of referring individual, organization or publication

About Your Dog

If adopted from shelter/rescue/pet store, please provide the name

How long have you had your dog?

Were there previous owner(s)?

If yes, why was the dog given up?

Have you owned other dogs in the past?

If yes, what breed(s)?

Physical/breed characteristics that contributed to your choice

Medical Information & History

Veterinarian's Name

Vet City

Month/Year of Last Visit

Reason for Last Visit

Date Last Vaccinated

Vaccine(s) Given

Current Health Problems/Medications

Past Medical Conditions/Treatment

Allergies (including food allergies)

Is your dog easily handled by vet staff?

Yes No

Has your dog ever been muzzled?

Yes No

Heartworm Preventative?

Yes No

Heartworm Brand

Flea/Tick Preventative?

Yes No

Flea/Tick Brand

May we contact your vet about health/behavioral issues?

Yes No

If yes, please initial

Diet and Elimination

Type of Food (raw, dry kibble, canned, etc.)

How Often?

How Much?

At approximately what times?

Does your dog finish all food at meals?

Yes No

If not, how long is food left down?

Does your dog receive treats/chewies?

Yes No

Frequency/Type

3 of your dog's favorite foods/treats

Has your dog been possessive of food/treats?

Yes No

If yes, please describe in detail

Is your dog reliably housetrained?

Yes Mostly (infrequent accidents) No

Dog Door?

Yes No

Times daily let out/walked to eliminate (when home)

Times per day dog normally defecates

Exercise

Type of exercise (if none, note "none" and reason)

How long/how often? (e.g., "15-minute walk 3x daily")

Who is normally responsible for exercising your dog?

Collar and leash type used on walks

Does your dog become reactive toward dogs or people on walks?

Yes No

If so, please describe

Environment & Lifestyle

Household Members (name, gender, age, relationship to you)

Who will be responsible for practicing training exercises?

Does the dog "belong to" a particular member or everyone?

Does any household member dislike the dog? Why?

Is any household member frightened of the dog? Why?

Is the dog frightened of any household member? Why?

If confined indoors, how?

When home, is your dog allowed in the house?

Yes No

Ever confined (crated/penned) while you're home?

Yes No

If confined, how?

How long confined on average day?

Reason for confinement

If outdoor dog, would you like him indoors eventually?

Yes No

Where does your dog sleep at night?

In a crate?

Yes No

Hours per day without human companionship

Other pets? (kind, breed, age, sex, neutered)

How does your dog get along with other pets?

Does your dog play with toys/games?

Yes No

Favorite toys/games

Other activities your dog enjoys

Five things you LIKE about your dog

Five things you would change about your dog

Training History

Previous training history

Group class completed?

Private lessons?

Sent to trainer/boarded?

Trainer name/organization

Training methods used

Behaviors your dog knows

Behaviors your dog performs reliably (% of the time)

Behavioral Issues

Please describe the behavioral issues in detail

What procedures have you tried to correct these behaviors?

Biting & Aggression History

Has your dog ever bitten a person?

Yes No

Has your dog ever bitten another animal?

Yes No

If yes, please describe the bite incident(s) in detail

Did any bite require medical attention?

Yes No

If yes, please explain

How does your dog react to strangers visiting your home?

When was the last time a stranger visited your home?

Training Goals

What do you hope to accomplish with training? What would you like help with?

Any additional information you'd like to share