Intake Form - Positive Dog Coach

Name

First

Last

Date

Email

Address

City

State/Province

Zip/Postal

Country

Phone

About Your Pup

Information About Your Dog

Dog's Name

Breed / Mix (if you know)

Dog Gender

Male

Female

Age or Approximate Age

Weight

Status

Intact

Neutered

Spayed

At what age was your dog spayed / neutered?

Medical Information

Has Your Dog Been Vaccinated for: (please provide documentation)

Are There Any Current Health Issues

Diet Information

What type of food do you feed your dog?

What type of Treats do you give your dog?

Does your dog ever display possessiveness of his/her food?

Lifestyle Information

How often do you exercise your dog?

What kinds of exercise do you give your dog?

What type of collar / leash do you use for your dog?

Is your dog reactive around other dogs?

Yes

No

Please Describe

Where is your dog kept when you are not at home?

How many hours per day is the dog alone?

How many hours per day is the dog confined?

Do you have other pets in the household?

Yes

No

What Kind of pets do you have?

How does your dog interact with the other household pets?

Have you already done training with your dog?

Yes

No

What kind of training have you done?

Check any cues that your dog knows:

Check any undesirable behaviors that apply to your dog:

List any training or tools you have used or are using to address the behaviors checked above.

Has your dog ever bitten a human or other animal?

Yes

No

Explain the situation and if the bite required medical information.

What do you hope to accomplish with dog training. Prioritize your goals.