New Client Forms

Training Forms!

For anyone interested in setting up training, please fill out the following forms to the best of your ability. If you are interested in private training sessions, I will review your forms and be in touch regarding scheduling.
-Form 1: All Clients Dog Background is for every client to fill out, including those interested in behavior modification.
-Form 2: Behavior Consultations is only for those clients interested in behavior modification sessions.

Form 1: All Clients

Form 2: Behavior Clients

Form 1: All Clients Dog Background

* Indicates required field

Owner name and profession *

Co-owner name and profession *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Veterinarian name, clinic and phone number *

How did you hear about Canine Mind? *

Dog name *

Dog age and breed *

How long have you had your dog? *

Where did you get your dog? *

If adopted, what do you know about your dog's life before you? *

How old was your dog when you got them? *

Where does your dog sleep at night? *

How long is your dog alone each day? *

What other pets live in the home? *

Is your dog crate trained? How do they feel about the crate? *

How often do you exercise your dog and what type of activities do you do? *

How many training sessions do you do per week and for how long? *

How many minutes/day can you dedicate to working with your dog? *

Has the dog ever growled at you or other family members? If yes, please explain. *

Has the dog ever snapped/bitten you or other family members? If yes, please explain. *

Has the dog ever snapped/bitten friendly strangers? If yes, please explain. *

How does your dog respond to grooming (brushing, petting, nail clipping, etc.)? *

Please list, in order of preference, your dog’s favorite rewards (praise, toys, food, pets, play, etc.): *

Does your dog ever: *

Not respond to you Dart out open doors Chase or lunge at moving objects Dig somewhere you don't want them to Inappropriately bite, mouth, or chew Ignore you or run away when called Jump up on people Climb on furniture, tables, counters (if not permitted) Urinate/defecate inside the house (potty trained dogs only) Pull excessively on the leash Know any basic behaviors (sit, down, etc) React overexcitedly to other dogs, people, moving objects Attend/has attended other dog training Get into trash or dirty laundry Become possessive of/guard food Become possessive of/guard toys Become possessive of/guard spaces Become possessive of/guard people React negatively to some/most other dogs React negatively to some/most other strangers Mount/hump other dogs or people Hide for any reason (thunder, fireworks, vacuum) Growl from a distance at other dogs/people

Please rank your dog on a scale of 1-5 (1 is the least, 5 is the most) on the following:

Anxiety/fearfulness *

Confidence *

Obedience *

Relationship with your dog *

What are your goals with/for your dog? *

Submit

Form 2: Behavior Consultations

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Describe your dog’s personality *

Has your dog experienced any sudden behavioral changes? (Those that have occurred at the drop of a hat) *

Is your dog intact/neutered/spayed/female/male? *

Has your dog ever been severely underweight or starved? *

When was your dog’s last vet exam? *

Does your dog have any physical injuries, disability or medical conditions? *

What kind of freedom of movement has your dog had before your home? Chained up, crated, free roaming, etc. *

What kind of environment did they live in before your home? (urban, suburban, rural, etc.) *

What opportunities does your dog have to express natural behaviors? Digging, chewing, running, hunting, etc. *

- Does your dog have ____ in their environment? *

Children Dogs Cats Other small animals Elderly people Toys Enrichment activities like slow feeders, snuffle mats, kongs, etc. New people Access to indoors Access to outdoors None Other

If other, please explain: *

Have there been any changes in your dog’s environment? *

What training tools are currently being used? (Prong, E-collar, treats, muzzle, etc.) *

What daily exercise does your dog get *

How often do you play with your dog? *

If this is a consult for a specific behavioral issue, what preceding events trigger this behavior? *

What has been the historic atmosphere of your dog’s relationship with humans? *

Does anyone in the family suffer from any condition that might alter your dog’s perception of the environment? Depression, anxiety, illness, etc. *

Are there any social cues or movements that change your dog’s behavior? (bending over, raised voices, petting, etc.) *

What is your dog’s daily routine? Do they have one? *

What patterns of behavior (If X happens, I do Y) does your dog currently know? IE: if there’s a knock at the door, I BARK! *

What patterns of behavior would you like your dog to know? *

Do you talk to your dog? *

What would you say that your relationship with your dog is based on? (Trust, fear, love, physical constraint) *

Do you have “house rules” that your dog is expected to follow? Does everyone in the house follow those rules? *

Submit

training_liability_waiver_canine_mind_llc.pdf
File Size:	89 kb
File Type:	pdf

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Get in touch!

Email: [email protected]