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Please complete ALL fields!
All information that you provide is confidential.
It is important to answer carefully as your answers will be used to evaluate your dog's behavior problem.
Please answer ALL questions. If a question does not apply to your dog or situation, answer with "N/A."
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Pet Name |
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Nickname |
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Breed |
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Birthdate |
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Weight |
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Color(s) |
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Veterinarian Clinic |
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Vet Phone |
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Sex |
Male
Female
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If fixed, age done |
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Age Obtained |
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Where From? |
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Cost |
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Describe the area the litter housed |
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Describe the behavior of the littermates |
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Did your puppy appear shy or outgoing? |
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Is the dog housebroken? |
Yes
No
Sometimes |
If you did the housebreaking, please describe your methods in detail |
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Obedience Graduate? |
Yes
No
Not Taken |
If yes, describe in detail the type of training, equipment used, etc |
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Date of prior training |
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Where? |
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Was it group or private? |
Group
Pvt |
What commands does the dog still perform well? |
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Where does the dog sleep at night? |
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Is the dog allowed on the furniture? |
Yes
No |
Describe your home - apt, duplex, single home, etc
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What is your dog's favorite food treat? |
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What brand of food is fed? |
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Amount of food? |
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How often? |
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Who feeds the dog? |
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Treats given? |
Yes
No |
Table Scraps? |
Yes
No |
Does the dog beg? |
Yes
No |
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Last veterinary appointment |
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Reason for appointment |
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Briefly describe your pet's health history. |
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Current and previous medications |
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Does your dog suffer from any physical condition that might contribute to the problem? |
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| Environmental Information |
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List the people in the household and their
ages.
Give status of each person:mom,dad,uncle, etc |
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Number of children. Sex and age of each |
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Other pets |
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What pets have you previously owned? |
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If your previous pets had behavior problems, what
were those problems? |
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Please describe the dog's daily exercise routine |
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Is your yard fenced? |
Yes
No |
Describe the dog's exercise area |
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How long is the dog exercised daily? |
15 M.
45 M.
1 Hr.
2 Hr. |
What types of play does your dog enjoy most? |
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Describe your dog's reaction to be left alone |
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Describe your dog's behavior when you return home |
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Do you use a crate? |
Yes
No |
How many hours a day does your dog spend in a crate? |
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What toys does the dog have? |
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Behavior Information
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Pet's age when the problem was first noticed |
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Describe in detail the events of the first instance |
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What seems to trigger this problem? |
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What was your response to this behavior? |
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Describe any punishments you have administered. Be honest
and detailed. |
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How often does this problem occur? |
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Has there been a recent change in the frequency or severity? |
Yes
No |
Have there been any changes in the household that might explain the appearance of the problem? Explain. |
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Besides the punishments described above, what else have you done to try and correct this problem? |
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Have you seen other trainers about this problem? What
did they suggest? |
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Why do you think this behavior is occurring? |
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Have you thought of giving up, or having this pet
put to sleep? |
Yes
No |
Why haven't you given up your pet? |
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What is your goal with this training? |
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Provide us with any other details that might be
helpful |
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What is your budget for this training? |
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Other: Please describe |
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| Customer Information |
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Behavior Appointment / Schedule Date
Private sessions are scheduled between 9:30 am and 2:30 pm, M-F |
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Alternate Day and Time |
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Time
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