Dog Training: Client Form - Dakine Canine, LLC

Please fill out the intake form the best you can. This helps me understand your dog better and design a custom training plan. We will discuss your answers during the initial consultation. Mahalo.

Date:*

Owner’s Name*

Address*

City*

State*

Zip*

Home Phone

Cell Phone*

Best times to contact*

Email*

Type of housing*

House

Townhome

Apartment

Other

Fenced yard?*

Yes

No

Invisible fence?*

Yes

No

How did you hear about Dakine Canine, LLC?

Name of referring individual, organization or publication:

May we post photos and/or video of you and your pet on our social media and/or website?*

Dog’s Name*

Breed/Mix*

D.O.B. or age of dog*

Weight*

Dog Gender*

Male

Female

Is your dog Neutered/Spayed*

Yes

No

If spayed/neutered, at what age?

Where did you obtain your dog?*

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

How long have you had your dog?*

Were there previous owners?*

Yes

No

If yes, why was the dog given up?

Why did you get your dog? Please check all that apply:*

Have you owned other dog(s) in the past?*

Yes

No

If yes, what breed(s)?

MEDICAL INFORMATION & HISTORY: Veterinarian’s Name*

Veterinarian’s Clinic Name and Location*

Month/Year of last visit*

Is your dog up to date on vaccines?*

Yes

No

Vaccine(s) given. Check all that apply.*

Rabies

DHPP (distemper, hepatitis, parvovirus, parainfluenza)

DHLPP (distemper, hepatitis, parvovirus, parainfluenza, leptospirosis)

Leptospirosis

Bordetella

Other

Current health problems/medications?*

Past medical conditions/treatment?*

Does your dog have any allergies or diet restrictions, including food allergies?*

Is your dog easily handled by the vet staff?*

Yes

No

Has he/she ever had to be muzzled?*

Yes

No

Is your dog on heartworm preventative?*

Yes

No

Is your dog on flea and tick preventative?*

Yes

No

May we contact and discuss health and behavioral issues with your veterinarian?*

Yes

No

DIET AND ELIMINATION: What type and brand of food do you feed? (e.g., Science Diet dry kibble, canned, raw)*

How often?*

How much?*

Does your dog finish all food at meals?*

Yes

No

If not, how long is the food left down?

Does your dog receive other treats/chewies?*

Yes

No

Frequency/type:

Please list 3 of your dog’s favorite foods/treats:*

Has your dog ever become possessive of his food or a treat?*

Yes

No

Please describe in as much detail as possible

Is your dog reliably house trained?*

Yes

Mostly infrequent accidents

No

Is your dog crate trained?*

Yes

No

Paper/pad trained?*

Yes

No

Do you have a dog door?*

Yes

No

How many times daily do you let your dog out to eliminate?

EXERCISE: What type of exercise does your dog get? (If not receiving any exercise at this time, note “none” and the reason.)*

How long does the exercise last/how often is it provided? (For example, “a 15-minute walk three times daily,” or “plays with neighbor’s dog for an hour once a week.”)*

Who is normally responsible for exercising your dog?*

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

Yes

No

If yes, please describe your dog's behavior

List all people, including yourself, who live in your household*

Who will be responsible for practicing training exercises with the dog?*

Does your dog “belong to” a particular household member (e.g., son) or everyone?*

Do any household members dislike the dog, and if so, why?*

Are any household members frightened of the dog, and if so, why?*

Is the dog frightened of any household members, and if so, why?*

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

If indoors, is your dog ever confined (crated, penned) while you are home?*

Yes

No

How are they confined (e.g. crate)?

If so, how long is your dog confined on an average day?

Reason for confinement:

If your dog is not allowed indoors at all, why not?

Where does your dog sleep at night?*

How many hours per day is your pet without human companionship?*

Do you have other pets?*

Yes

No

If so, what kind, breed, age, sex, neutered?

How does your dog get along with the other pet(s) in the house?

What are your dog's favorite toys/games? (These may be interactive games like tug or toys he/she plays with alone.)*

What other activities does your dog enjoy?*

Three things I like about my dog:*

Three things I’d like to change:*

TRAINING: previous training done?*

List organization name and/or trainer’s name:

Training methods used (check all that apply):*

Choose the behaviors your dog knows.*

Please list the behavior concern(s) or what you wish to address with your dog in order of importance.*

What have you tried to do to change the problem behavior(s)? Please list all things you have tried whether they have been useful or not.*

Have there been any recent changes in the household (new pet, new family member, schedule change, etc.)? If so, describe:*

Has your dog ever bitten anyone?*

Yes

No

If yes, please explain in as much detail as possible.

Has your dog ever bitten any non human animals?*

Yes

No

If yes, please describe in as much detail as possible.

Has medical attention been necessary (for humans or animals) because of any aggressive incident?*

Yes

No

If yes, please explain:

Have you ever considered finding another home for your dog or giving him/her to a shelter?*

Yes

No

Have you ever considered euthanasia (putting your pet to sleep)? *

Yes

No

What is your dog’s usual reaction when a person he/she has not met before enters the home?*

When was the last time a person unfamiliar to your dog entered the home?*

Where is the best place for us to park when visiting you home?*

Is there anything else you feel it would be important for me to know?*