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New Client Intake Form
Please fill out this form as thoroughly as possible. This will allow me to have an understanding of your home life and goals, which will aid in developing a plan for you and your dog.
Following submission of your form, I will reach out to you to further discuss training with you and your family. and schedule you for our first lesson.
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Client Information
Today's Date
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MM
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DD
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YYYY
Client (your) Name
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Your answer
Primary Phone Number
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Your answer
Primary Email Address
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Your answer
Home Address
Your answer
How/where did you hear about us?
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Your answer
Dog's Information
Dog's Name
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Your answer
Dog's Age (or estimate)
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Your answer
Dog's Breed or Mix
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Your answer
Is your dog...
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Male
Female
Where did you get your dog?
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Your answer
How long have you had your dog?
Your answer
About Your Home Life
Who lives in your home? Please list the ages of everyone living in your home/interacting with your dog.
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Your answer
Have you moved with your dog in the last 12 months?
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Yes
No
Have you added or lost any family/house members in the last 12 months?
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Yes
No
What other pets live in your home? Please list name, species, and age.
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Your answer
Have you lost or added any pets (aside from the trainee) in the last 12 months?
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Yes
No
About Your Dog's Lifestyle
Where is your dog when home alone?
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Your answer
Where is your dog overnight?
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Your answer
Does your dog have a crate?
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Yes
No
If yes, does your dog like the crate?
Yes
No
Sometimes
Clear selection
Where is the dog's crate located in your home?
Your answer
How many hours is your dog home alone on average?
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0-2
2-4
5-7
8-10
10+
How much, and how often , does your dog eat?
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Your answer
Is food left out for your dog to eat as desired?
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Yes
No, my dog is fed at certain meal-times
What kind of toys does your dog have daily access to?
Nylabones/benebones
Stuffed animals
Rope toys
Kongs
Tennis balls
Frisbees
Food dispensing toys
Other
How often does your dog go on a walk?
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Your answer
Who walks the dog?
Your answer
How long is your average walk?
Your answer
Does your dog enjoy any other type of a physical exercise?
Your answer
Does your dog ever walk off leash?
Yes
No
Clear selection
Does your dog go to dog parks?
Yes
No
Clear selection
Does your dog pull on walks?
Yes
No
Clear selection
If your dog pulls, what, if anything, have you done to try and change this behavior?
Your answer
About Your Dog's History
Has your dog ever growled at a person or other dog (outside of play?)
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Yes
No
If yes, please describe what happened:
Your answer
Has your dog ever bit/nipped a person or other dog?
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Yes
No
If yes, please describe what happened:
Your answer
If your dog has nipped/bitten a person or animal, was there a tear, scratch, bruise, bleeding, or puncture? Check all that apply
Tear
Scratch
Bruise
Bleeding
Puncture not requiring stitches
Puncture requiring stitches
Is your dog nervous/fearful of new people in your home?
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Yes
No
If yes, please describe what you see from your dog when people are in your home.
Your answer
Please check any of the following tools that you currently use or have previously used with your dog:
Martingale Collar
Prong Collar
No-Pull Harness
E-collar
Spray bottle
Bark Collar
Citronella Collar
Gentle Leader
Choke Chain
Clicker
Regular Harness
About Your Goals
Please tell me 5 things you like about your dog, or that your dog does well.
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Your answer
Please tell me 5 things you wish you could change about your dog.
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Your answer
What made you reach out to us for training assistance?
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Your answer
What would you like to accomplish through training?
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Your answer
How would your ideal dog behave?
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Your answer
Thank you for taking the time to fill out our registration form. These details will help us better serve you and your dog. We look forward to working with you!
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