First Name: Last Name:

Address:

City: State: Zip Code:

Phone: Email:

Physical and Medical Issues

1. What is the name, address, and phone number of your veterinarian?

2. Is the dog current on vaccinations, including Bordatella?

3. When was the dog’s last veterinary exam?

4. Does the dog have any known medical problems?

5. Is the dog on any medication?

6. Is the dog spayed/neutered?

7. Does the dog have any food allergies?

Feeding, Treats, and Chew Items

1. What type of food is the dog being fed?

2. How many times a day is the dog being fed? At what times?

3. Does the dog eat right away and finish the entire meal?

4. What type of treats, cookies, or chew items does the dog get, and how often?

5. Where is the dog fed and who is nearby when he eats?

6. Who does the feeding?

7. Does the dog get “people” food and if so, at what location?


Logistics

1. Where does the dog sleep?

2. Is the dog allowed on the furniture?

3. Where does the dog eliminate?

4. Where is the dog kept when no one is home?

5. What is the average length of time that the dog is left alone?

6. What is the percentage of time that the dog spends indoors versus outdoors?

Training

1. Has the dog had any previous training? (Describe familiar cues, methods, and who did the training.)

2. Describe how you reprimand, correct, or punish your dog for unwanted behavior.

3. Describe how you reward your dog for good behavior.

4. Who will be responsible for training the dog?

General Information

1. List three behaviors in order of importance that you would most like to change about your dog’s behavior.

2. Is the dog housebroken? Crate trained?

3. What kind of exercise does the dog receive?

4. Describe a typical day in the life of your dog.

5. What is your dog’s favorite toy or game?

6. What is your dog’s favorite activity?

7. What is your dog’s least favorite thing?

8. Can family members handle the dog physically? Bathe? Trim nails?

9. Does the dog get in and out of your vehicle unaided?

10. Do you plan to do any type of competition, dog sport, or therapy related activities with your dog?