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Dog Training: Client Form

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:

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Owner’s Name

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Address

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City

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State

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Zip

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Home Phone

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Cell Phone

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Best times to contact

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Type of housing

House

Townhome

Apartment

Other

Fenced yard?

Yes

Invisible fence?

Yes

How did you hear about Dakine Canine, LLC?

Veterinarian

Former client

Island Dog Magazine ad

Truck advertisement

Internet

Pet-related business

Rescue/Shelter

Facebook

Instagram

Other

Name of referring individual, organization or publication:

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

Me and my dog

My kids and my dog

Dog only

No photos

No videos

Dog’s Name

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Breed/Mix

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D.O.B. or age of dog

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Weight

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Dog Gender

Male

Female

Is your dog Neutered/Spayed

Yes

If spayed/neutered, at what age?

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Where did you obtain your dog?

Breeder

Individual

Shelter

Rescue Group

Pet Store

Friend/Relative

Found stray

Other

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

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How long have you had your dog?

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Were there previous owners?

Yes

If yes, why was the dog given up?

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

Companionship

For the kids

For protection

To breed

Received as gift

Sports/Work

Competition obedience

Agility

Hunting

Assistance/Service dog/Therapy dog/Emotional Support dog

Companion for other dog

Other

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

Yes

If yes, what breed(s)?

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MEDICAL INFORMATION & HISTORY: Veterinarian’s Name

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Veterinarian’s Clinic Name and Location

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Month/Year of last visit

Is your dog up to date on vaccines?

Yes

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?

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Past medical conditions/treatment?

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

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Is your dog easily handled by the vet staff?

Yes

Has he/she ever had to be muzzled?

Yes

Is your dog on heartworm preventative?

Yes

Is your dog on flea and tick preventative?

Yes

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

Yes

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

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How often?

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How much?

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Does your dog finish all food at meals?

Yes

If not, how long is the food left down?

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Does your dog receive other treats/chewies?

Yes

Frequency/type:

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

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

Yes

Please describe in as much detail as possible

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Is your dog reliably house trained?

Yes

Mostly infrequent accidents

Is your dog crate trained?

Yes

Paper/pad trained?

Yes

Do you have a dog door?

Yes

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

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

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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.”)

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Who is normally responsible for exercising your dog?

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

Yes

If yes, please describe your dog's behavior

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

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

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

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

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

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

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

Indoors not confined

Indoors confined

In yard not confined

In yard confined to dog run

In yard tied out or chained

Other

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

Yes

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

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

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Reason for confinement:

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

Allergies

Cleanliness

Not housetrained

We prefer it

Destructive

Other

Where does your dog sleep at night?

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

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Do you have other pets?

Yes

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

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

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

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What other activities does your dog enjoy?

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Three things I like about my dog:

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Three things I’d like to change:

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TRAINING: previous training done?

Trained him/her ourselves

Puppy group

Basic group

Intermediate or advanced group

Private lessons

Board and train

Other

List organization name and/or trainer’s name:

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Training methods used (check all that apply):

Food treats

Praise

Verbal corrections

Physical corrections

Ecollar or shock collar

Choke collar

Prong collar

Other

Choose the behaviors your dog knows.

Sit

Lie down

Stay

Come

Walk nicely on leash

Leave it

Drop it

Wait

Go to your place/mat

Watch me/look

Off (furniture or when jumps up)

Fetch

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

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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.

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

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Has your dog ever bitten anyone?

Yes

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Has your dog ever bitten any non human animals?

Yes

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

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

Yes

If yes, please explain:

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

Yes

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

Yes

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

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

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

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

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